Menopause

Menopause Is ‘Overmedicalized,’ Experts Say, but Not All Agree

A new series from The Lancet highlights the medicalization of menopause, sparking debate between medical professionals about how menopause is treated.
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Menopause Is ‘Overmedicalized,’ Experts Say, but Not All Agree
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Jennifer Galardi
5/6/2024
Updated:
5/6/2024
0:00

What for many years used to be considered a taboo topic—menopause—recently has become a source of much debate both inside and outside the medical community.

The increased attention prompted The Lancet to come out with a series on menopause in March to explore this natural phase of a woman’s life and urge a more balanced conversation surrounding how it is treated and managed.
However, many in the medical community, including Stanford Medicine, have come out with statements critiquing the series and “reject the idea that treating menopause frames it as a disease.”

Is Menopause Overmedicalized?

The opening editorial to The Lancet’s series states that the overmedicalized view of menopause is misguided.

The term “overmedicalized” can be vague, Dr. Heidi Nelson, a professor in the Department of Health Systems Science at the Kaiser Permanente School of Medicine in Pasadena, California, told The Epoch Times in an email. “As used in the Lancet articles, [overmedicalized] describes how the experience of menopause has been reduced to a medical problem requiring treatment without considering social, cultural, and political influences, or personal context,” she said. But people should not conflate the word “overmedicalized” with “overmedicated.”

Dr. Nelson said the short-term treatment of vasomotor symptoms with hormone replacement therapy (HRT) to reduce hot flashes, night sweats, and sleep disturbances and to improve vaginal dryness with hormones is appropriate for women and would not be considered overmedicalization.

There are four papers in The Lancet series, each focusing on a different aspect of the menopause experience:The authors emphasized diversity, particularly in the first paper, suggesting that women in different cultures experience menopause differently, and this should be considered. The proposed model of empowerment “recognises factors modifying the experience, in which the patient is an expert in their own condition and the health-care worker supports the patient to become an equal and active partner in managing their own care.”
Social media and private providers sometimes portray menopause as a catastrophic event with a long list of symptoms that all women experience. However, studies show that only about 14 percent of women have severe symptoms during menopause, and about 20 percent have no symptoms. The rest are somewhere in between.
“There are many ways to make it through the menopausal transition with greater comfort … and each of them involves a different set of risks and benefits, and effort, and cost,” Andrea LaCroix, one of the essay’s authors and an epidemiologist at the University of California–San Diego, told STAT. Ms. LaCroix added that large and diverse studies comparing treatments head-to-head are scarce. “It’s a biased statement to say hormone therapy works the best.”

Dr. Louise Newson, a general practitioner in the UK who specializes in menopause, told The Epoch Times via email that “menopause is more than a collection of symptoms; it is a cardiometabolic and inflammatory condition which leads to an increased risk of numerous diseases.”

Dr. Newson says many of the symptoms of menopause have been misdiagnosed, leading to the prescription of drugs, including antidepressants, antipsychotics, painkillers, sleeping pills, anticholinergics to treat bladder symptoms, and heart-related medications to lower cholesterol, reduce blood pressure, and control palpations.

The Lancet series editorial argues that symptom management and medicalization should be replaced with a “model of health empowerment.” The editorial cites the World Health Organization’s definition of empowerment as “an active process of gaining knowledge, confidence, and self-determination to self-manage health and make informed decisions about care.”

Social Media Influencers

Doctors, celebrities, and social media influencers are all speaking up about this phase of a woman’s life, offering a wide range of advice. Even a quick search of the term “menopause” on Instagram returns a slew of accounts claiming to specialize in menopause treatment and therapy.

Many women’s health practitioners have expressed frustration that celebrities and media headlines are making too much of a fuss about menopause, particularly on social media.

Dr. Sarah Ball, a popular general practitioner and menopause specialist in London, expressed her disappointment in The Lancet review in a post on Instagram. “Menopause is not a disease ... But it is associated with a number of significant health risks too. The potential risks vary widely from person to person. That is in no way meant to scare anybody about the prospect of menopause, BUT to empower women who have hitherto been kept pretty well in the dark by a society that is only just waking up to the idea that women’s health has been relatively neglected for centuries.”
Many clinical doctors in large-scale research hospitals are skeptical of practitioners with a sizeable social media following. They struggle to understand why anyone would take offense to the central concept of the empowerment model proposed in the report. The model advocates for women to have access to high-quality information, empathetic clinicians willing to listen and provide treatment if women want it, and workplaces that can be adapted to meet the needs of women who experience symptoms during their day.

The Risks vs. Benefits of Hormone Replacement Therapy

The effect of hormones and women’s monthly cycles became a topic of controversy when a now well-known study called the “Women’s Health Initiative” (WHI) reported in 2002 that estrogen plus progestin treatments resulted in a 26 percent increase in breast cancer in postmenopausal women. This led to an early halt to the study that began in 1993 and was supposed to run until 2005 to determine whether or not hormone replacement therapy (HRT) could reduce the risk of heart disease, the No. 1 cause of death for women.
The National Institutes of Health (NIH) publicly announced the study in a press conference. The study’s wide acceptance in medical literature and media led women to discontinue their hormone treatments.
Since then, many medical professionals have rallied against the finding, citing flaws within the study, including errors in risk ratios, incidence, and age factors. Tara Parker-Pope, a health editor for the Washington Post and former columnist for The New York Times, outlined the study’s flaws in her book, “The Hormone Decision.” She said the NIH was going for “high impact” to “shake up the medical establishment and change the thinking about hormones.”

Still, others claim that the benefits of symptom management with HRT must be balanced with the risks of its use for chronic disease prevention.

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Dr. Newson is an advocate for body-identical HRT. “Unlike the old-fashioned types of HRT, body-identical HRT is very safe,” she said. “And for most women, the benefits of body-identical hormone replacement will significantly outweigh any risks. For most women, there are no risks of replacing their missing hormones.”

However, Dr. Nelson, who prefers the current term “menopausal hormonal therapy” (MHT), says risks still exist and must be considered. She highlighted the WHI and the U.S. Food and Drug Administration (FDA) as sources of information on potential risks associated with HRT. The WHI identifies long-term risks such as breast cancer, blood clots in the legs or lungs, and stroke, while the FDA warns of the short-term side effects, including irregular vaginal bleeding leading to the need for more invasive symptom investigation.

HRT may not effectively alleviate many of the symptoms women often attribute to menopause. According to Dr. Nelson, hormones primarily reduce hot flashes, night sweats, and vaginal dryness, symptoms specific to menopause. “The other symptoms attributed to menopause are not caused by menopause itself but can coexist,” she said. Women’s sleep disturbances are likely related to the hot flashes, resulting in brain fogginess or mood fluctuations during the day, and other more specific treatments should be used for these symptoms. Dr. Nelson suggests using cognitive behavioral therapy (CBT) or antidepressant medications, which can be more effective in treating anxiety and depression.

Women who undergo HRT may also experience a reduction of symptoms due to a strong placebo effect.

‘Menowashing’

Dr. Nelson expressed concern about the increased public focus on menopause leading to a proliferation of products in the marketplace claiming to alleviate symptoms targeting women who “are vulnerable and seeking help anywhere they can find it.” She cautions women to be wary of aggressive marketing.

Dr. Newson said women can find everything from supplements to chocolate marketed for menopause, each claiming to help ease their suffering. “While it can appear sympathetic, consumers can easily misunderstand the supposed benefits for them.” She refers to these marketing tools as “menowashing.”

“The missing piece in the room here is that there is an enormous and very, very lucrative industry around certain products and services to women around menopause,” Dr. Newson said. Educating women about how to take charge of their health is vital to reducing the impact of marketing.

The one thing most experts agree on is that treatment for menopause symptoms cannot be a one-size-fits-all approach. Both sides are adamant about female empowerment. This means putting women at the center of the issue and trusting they are intelligent and capable of making informed decisions about their own treatment in partnership with their health clinicians.

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Jennifer Galardi
Jennifer Galardi
Author
Jennifer Galardi spent decades as a health and wellness expert before receiving a masters in Public Policy from Pepperdine University. She writes about health, culture, and policy and her work can be seen in The New York Sun, The Blaze, and The American Spectator, along with countless health outlets.
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