Menopause

“Feminists in the 1980s and 90s by criticizing medicine’s construction of women as weak and vulnerable, themselves construct women, who do not actively resist this medicine, as passive. Because these modernist feminist critiques conceive of knowledge as fixed, their arguments coalesce around contests about the ‘real’ menopause. As a result the shifting focus of knowledge about menopause from constructions based on concepts of femininity to those based on the relationship of menopause to prevention of ill health is not brought into modernist feminist explanations of menopause and health care at menopause. Rather, associations of menopause with chronic diseases are deployed as further examples of the exploitation of ‘menopausal and postmenopausal women’: that this particular construction of menopause may have implications for contemporary medical practice is not considered outside the framework of ‘exploitation’ (Murtagh & Hepworth, 284). . . . By the late 1990s articles in professional academic medical journals constructed a triadic argument about menopause and decision-making: menopause is a marker for prevention; hormone replacement therapy, the key preventive pharmaceutical brings with it both risks and benefits; women must make an ‘informed decision,’ with the assistance of her medical practitioner and based on an assessment of her personal risk profile. . . . As a concept upon which to based decision-making, individual choice fails to account for differences of power in society, it fails to account for social inequality and social difference. Indeed, it is itself a strategy of power which reinforces these inequalities by bringing a moral force to their existence (Murtagh & Hepworth, 2003b). . . . In this way the construction of menopause as a risk factor acts as a technology of power [i.e., for physicians]. This is one which is supported and perpetuated in the discourses available through health professionals and mass media. The menopausal women as a consumer of health information and health advice is left between a rock and a hard place: there exists a moral imperative to choose but the grounds upon which you might do so (the biomedical evidence) are continually shifting. Defining menopause through discourses of risk and prevention of disease thereby limits the possibilities for choice outside a medical framework” (285-86). “Health narratives [of middle-aged women re menopause] also tackle the important issue of ‘health choice and risk.’ Cf. Greene, Thompson & Griffiths, 280): This raises questions around: what is informed choice, who is responsible for that informing and how much information in ‘enough’? Are these circumstances where a health professional should persuade rather than aim to inform? How is ‘risk’ defined and communicated? Such narratives raise the complex issues of power, empowerment, knowledge and understanding within the patient/practitioner relationship.” Furthermore, decisions re HRT “are rarely made upon purely scientific or medical grounds, they also reflect present concerns and embodied experiences such as the loss of confidence and self-esteem associated with weight gain” (284).