Home Medizin Haben wir die Menopause übermäßig medizinisch behandelt?

Haben wir die Menopause übermäßig medizinisch behandelt?

von NFI Redaktion

The prevailing belief that menopause is an endocrine deficiency has led to a „disease-based model“ that results in the over-medicalization of this inevitable life transition, as stated in the first article of a major series published in The Lancet. The multinational author team called for a shift in attitude towards a more empowering approach that emphasizes menopause as „a normal, healthy phase in women’s lives.“

They noted that women’s experiences are highly varied and influenced by psychological, social, and contextual factors, many of which are modifiable. „While symptom management is important, the medicalized view of menopause can be disheartening for women, leading to overtreatment and overlooking potential positive effects, such as improved mental health as they age and the absence of menstruation, menstrual disorders, and contraception.“

Co-author Myra Hunter, Emeritus Professor of Clinical Health Psychology at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, told Medscape News UK that physical symptoms can also be influenced by prevailing attitudes. Their work identified that psychological factors – including stress, negative views about menopause, embarrassment, feelings of loss of control, and concern about others‘ reactions – are linked to more problematic menopausal symptoms.

Menopause, Misogyny, Medicalization… and Ageism

„The way women perceive and react to hot flashes, for example with embarrassment or attempting to hide symptoms, tends to be associated with negative ideas about menopause,“ she explained. She highlighted that viewing menopause solely as a treatable hormonal deficiency fuels negative expectations that can be harmful to women.

She added that while there are similarities with health conditions experienced by other women, such as pregnancy, menopause differs by being „inextricably linked to age“. Attitudes may therefore include „gendered ageism.“

In many Asian cultures, aging grants women respect and status rather than stigmatization, the authors explained. Women tend to experience menopause worse in countries where their value is based on youth and reproductive capabilities and aging is associated with decline.

Hunter emphasized, „Women in middle and older age play a key role in society. Women over 40 are the fastest-growing sector in paid and voluntary work in high-income countries and should be valued.“

Commercial Interests Portray Menopause as a Disease

The team also noted that much information about menopause „is driven by commercial interests,“ influencing the portrayal of hormone therapy in menopause and overshadowing evidence-based alternative options.

A lead article in the series stated, „Appropriating feminist narratives by commercial organizations positioning hormone therapy in menopause as a way to give women control over their bodies while downplaying risks further supports the portrayal of menopause as a disease.“

While it is said that all women desiring hormone treatment should be offered it unless contraindicated, the lead article emphasized, „Menopause does not herald the start of a period of decline and decay but is a developmental phase in life that can be successfully navigated with access to evidence-based information and appropriate social and medical support.“

Hunter urged doctors to acknowledge the diverse experiences in menopause. „Empowerment means approaching menopause with confidence and openness, being informed, and knowing that there are evidence-based treatments available if symptoms are challenging.“

Also commenting to Medscape News UK, Dr. Sarah Gray, an independent general practitioner in Truro in the western part of Cornwall who specializes in women’s health and was a member of the British Menopause Society Council, said that while the term „menopause“ technically refers to the final menstrual period, in common parlance it is used to signify the transition from reproductive to post-reproductive life.

The impacts on women are highly variable, she said. „While some welcome the loss of periods, the loss of ovarian hormones can have dramatic effects on the mental and physical health of others.“ Doctors must treat all women as individuals and respond appropriately to their challenges. Not all women need medical treatment, „but some undoubtedly do,“ and this should not be denied due to concerns about over-medication, she said.

Asked for comment by Medscape News UK, the British Menopause Society (BMS) also stated that it is important to provide appropriate care to women with significant symptoms that may be alleviated by hormone or other treatments.

Paula Briggs, BMS Chair and Consultant in Sexual and Reproductive Health, said, „In the past, there has been a lack of information about menopause, and some women found it difficult to get the treatment they needed. That is changing for the better.“ There is concern that the use of the term „over-medication“ could actually disempower women. „A balanced approach is important to ensure that women who need treatment actually receive it.“

Empowering Women to Shed Negative Narratives

Medscape News UK also spoke with Rachel Lankester, founder of MenoClarity, an information center on menopause, and Magnificent Midlife, a website designed to help women „let go of negative narratives about aging“, based on the book of the same name. She said, „Menopause is a natural transition, just like puberty, only our default setting is not to medicate puberty.“

Hormone therapy plays a role and can be helpful for some women, „but it’s just one tool in the toolbox,“ she said. „Medicalization is based on making money by scaring women into thinking menopause is a deficiency disease that can only be fixed with medication.“

It’s great that people are talking about menopause, „but the tendency towards negativity is real, especially in the media where scary headlines generate clicks and sales,“ she said. „Often, it’s those who have suffered the most who scream the loudest, and those who have had a neutral or positive experience are not heard.“

In Cultures Where Aging Enhances Status, Menopause is Easier

She also agreed that gender-specific ageism has implications. „In cultures where a woman’s status increases with age, menopause may be easier. If we fear menopause because we’ve been taught that it signifies the end of our value to society, that doesn’t bode well for our physical and emotional response to it. We also know that diet, lifestyle, mindset, environmental factors, stress, etc. have a massive impact on how women experience menopause.“

„Women in menopause are not on the fast track to illness, as some commentators seem determined to convince us, driving medicalization. We need more education and less fear-mongering so that we are prepared and not afraid.“

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