On the day I posted about A tiny thought of death a series on Menopause was published by the Lancet, which at first glance seemed like it was offering a positive and empowering message. Maybe I’m still getting over this awful cold or I’m feeling sensitive to the unrelenting attack on women's rights in this country or perhaps I’m right—this is the mirror world and nothing is as it seems.
In a series on Menopause by the Lancet, conveniently published on International Women’s Day and dripping with condescension, they warn of big corporations hijacking “feminist narratives” to promote non-evidence based health interventions—covertly, giving away their own intentions for the series?
Stigma
Lancet states by framing the natural period of transition through menopause as a disease of oestrogen deficiency that can be eased only by replacing the missing hormones fuels negative attitudes to menopause and exacerbates stigma.
Recently women have broken the silence that has existed around menopause, demanding to be seen and supported during this time in their lives, calling for care from doctors, treatment options and education. Lancet has twisted the long overdue attention on this topic into an accusation that ‘someone’ said hormone treatment was the ‘only’ way to address menopause. An attempt to shame women back into silence.
In reality, women can’t find a qualified doctor to support them during menopause. Only one in five OBGYN has received training menopause and residency programs across the nation don’t meet educational goals related to menopause in medicine1. So where do we find these ‘engaged clinician’s who will listen with empathy’ and support women in ‘shared decision making’ during menopause according to recommended treatment guidelines and research.
The negative attitudes and stigma towards menopause lies with our medical system, educational institutions and corporations, and not with women.
Disability
The Lancet reports concerns about interpreting menopause more broadly as a disability, risks further fueling the ageism and stigma that older women already face.
Let’s consider a disability as defined by the barriers and obstacles that exist between the person's experience and the support they need environmentally, socially and culturally. A disability resulting from the environment can be overcome by adapting, modifying or changing the environment to incorporate the support necessary for full inclusion of the individual.2
By providing women with access to educated doctors, medical care, hormonal treatment, accommodations in the workplace, and financial support we begin to address the existing social and cultural barriers that prevent women in menopause from full inclusion, health and wellness.
Diagnosis
The Lancet explains that women do not typically meet criteria for depressive, anxiety and psychotic disorders due to menopause, immediately after presenting research that indicates the increased risk to women’s mental health during the period.
Rather than writing off women with severe and debilitating menopause symptoms because they don’t fit into any of the existing disorders in the DSM, a new diagnosis should be created for people experiencing menopause symptoms that significantly impact and impair their ability to function in daily life. This would allow people to access treatment, ideally covered by insurance, support and accommodations from employers and help them to navigate and potentially overcome some of the current environmental obstacles and move towards greater well-being.
Also, they suggest that it can be difficult for women to differentiate menopause symptoms from concurrent life events such as caring for children at home, managing paid and unpaid employment, taking responsibility for aging parents, and balancing conflicting life roles. Undermining women’s ability to be the authority on their body and their experience.
Equality
If we are talking about equality for women, let’s talk about men! Because when an organization or group reports wanting equality for an oppressed group whom they are secretly trying to oppress and marginalize further, they never reference the dominant group.
As men get older, they are more likely to experience erectile dysfunction due to changes in hormones and cardiovascular functioning that come with age.3 Research suggests that over 50% of men aged between 40–70 years experience erectile dysfunction.4
Are we denying treatment to men experiencing erectile dysfunction and telling them that this is an opportunity for self empowerment? Are we asking men why they believe medication is the only option for treatment? Are we shaming men for wanting access to the recommended treatment and telling them that they are stigmatizing themselves by seeking out care? Are we telling men to be afraid of medication side effects and worried about global shortages of viagra? Are we suggesting they may be confused about the reason for their symptoms? Not at all.
Patients with erectile functioning challenges meet with their doctor for a complete health assessment and evaluation. They are evaluated for a diagnosis of erectile dysfunction, receive medical care and support, diagnostic testing, insurance coverage and support. The patient may potentially receive a referral to see a urologist, sex therapist and/or pelvic floor specialist as well as a prescription for an oral medication or hormonal treatment. Men receive comprehensive access to care allowing them to feel more empowered around their body and aging.
Women’s & Trans Rights
The message from the Lancet is that women are being hysterical, they are clueless about their own health needs, unable to make intelligent and informed decisions about what they need, further causing their own stigmatization and should simply take this opportunity to think positively about this wonderful next step of their life.
As the Lancet drives a wedge between women and access to hormonal treatment while telling women, we are on your side, I wonder if the writers lack cultural competency about what it means to be a woman in America today. Where in some states there is no OBGYN or planned parenthood in the county, having an abortion means your are subject to arrest and imprisonment, your a rapist can sue for joint custody, you can’t get divorced if you are pregnant, and forced to consider whether it’s even safe to get pregnant, begin IVF or get married any more.
At some points, buried between the lines, I hear faint calls to restrict access to hormone treatment not just for women but also for trans people, chipping away at our rights for choice and body autonomy. And if we look down the road a little further, are they suggesting that women don't need birth control, hormonal treatment or access to abortions under the guise of not wanting to over medicalize being a woman. Perhaps they hadn’t considered the powerful impact of suggesting women move away from hormonal treatment at this time in our culture.
Maybe the authors of this series had other reasons for recommending lifestyle and behavioral changes for women during menopause—their self interests which align with non-hormonal treatments, medical devices and CBT solutions for menopausal symptoms.
One good thing
The Lancet menopause series proposes that early menopause should be considered as being on a spectrum between premature ovarian insufficiency and menopause. And I couldn’t agree more.
Empowerment & Access
In summary, the Lancet has done an excellent job of hijacking a topic that is (finally) gaining some attention, downplaying evidence from current research about the emotional and physical challenges of menopause, to promote women’s empowerment through lifestyles and behavioral interventions.
Before we jump ahead to a utopian world, where women should feel empowered to make lifestyle and behavioral changes to manage menopause. We need to deconstruct internal bias towards women in our culture. We need a world where doctors don’t minimize or ignore women and are educated on menopause, women can ask for accommodations from employers without fearing discrimination or retaliation, women aren’t responsible for the majority of unpaid labor the comes from caring for aging parents, raising children and running a household, women can receive a diagnosis for severe menopause symptoms, coverage from insurance and access medication for severe menopause symptoms.
I believe a true model of empowerment begins with validating women’s experiences, acknowledging the silence and discrimination that exists in our culture around women’s aging and sexuality, recognize the enormous financial and career losses women have experienced through leaving their jobs, retiring early or change their hours due to severe menopause symptoms, how women have battled with hormonal related depression, anxiety and suicidal thoughts alone, how time and time again women continue to reach out to their doctors for support and received nothing.
Before we worry about women only using hormonal treatment to manage menopause symptoms and get overly concerned about women being exploited, let’s ensure hormonal treatment is actually an accessible treatment option for those with thoughts about death and other severe symptoms before we discuss controlling or limiting their access. Let’s appreciate what it means to distance women from hormonal treatment, comprehensive medical care and their decision to choose what is right for them in our current climate.
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Christianson, M. S., Ducie, J. A., Altman, K., Khafagy, A. M., & Shen, W. (2013). Menopause education. Menopause, 20(11), 1120–1125. https://doi.org/10.1097/gme.0b013e31828ced7f
Olkin, R. (2022, March 29). Conceptualizing disability: Three Models of Disability. Apa.org; American Psychological Association. https://www.apa.org/ed/precollege/psychology-teacher-network/introductory-psychology/disability-models
Ferrini, M. G., Gonzalez-Cadavid, N. F., & Rajfer, J. (2017). Aging related erectile dysfunction—potential mechanism to halt or delay its onset. Translational Andrology and Urology, 6(1), 20–27. https://doi.org/10.21037/tau.2016.11.18
Erectile Dysfunction. (n.d.). www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/erectile-dysfunction#:~:text=Erectile%20dysfunction%20is%20defined%20as