Sarah White, Chief Executive Officer of Jean Hailes for Women’s Health, is concerned by how many younger women at the organization’s health clinics come in attributing their symptoms to perimenopause, the period leading up to menopause. While perimenopause can happen as early as age 30, it typically doesn’t begin until women hit their mid-40s, and White notices that immediately blaming this transition is shifting attention away from other issues that cause symptoms. “Let’s sort out that there’s nothing else going on here,” she says.

This narrow focus on perimenopause is an expansion of a larger trend where menopause as a whole is treated as the underlying reason for any symptom or discomfort faced by middle-aged women—leading to prescriptions of antidepressants and other potentially harmful treatments.

While menopause, along with perimenopause, can cause unpleasant symptoms for some, many women go through the phase with little disruption. Unfortunately, the transition’s recent popularity has become a financial opportunity for commercial entities, who market their products by promoting the idea that menopause is a devastating medical emergency that all women need treatment for.

This medicalization has concerning parallels to what happens when normal reactions to troubling events are clinically diagnosed as anxiety or mood disorders. Just as neurotransmitters are blamed for feelings of distress, leading to the prescription of psychiatric drugs, the real root of women’s distress is overlooked in favor of medications that put them at risk of dangerous side effects and severe withdrawal syndrome.

Media’s Portrayal of Menopause

Online, menopause is often portrayed as something formidable. “There are relatively few positive role models,” says Martha Hickey, Professor of Obstetrics and Gynaecology at the University of Melbourne. “If you put ‘menopause’ into Google images, you’ll see endless pictures of women fanning themselves or passing out. We don’t often see positive images.”

Some of this is innocuous—“People don’t go online and say, ‘Hey, menopause was fantastic,’” says White. However, it’s also true that social media algorithms tend to amplify posts that incite more intense emotion, making users more likely to run into posts that take the most upsetting or exaggerated angles on menopause.

Not only that, menopause messaging is frequently driven by commercial interests. Women’s health is a popular commercial area, since brands selling health products often portray themselves as a trustworthy replacement for women abandoned by a medical establishment that deprioritizes their needs. Menopause is an especially lucrative area within women’s health because middle-aged women tend to have more disposable income than younger women, while menopause’s popularity as a topic has created a “hot flush gold rush,” where simply associating a product with menopause makes it easier to sell. (“Hot flushes” are known as “hot flashes” in the U.S. and Canada.)

“Health and medical research has really done a disservice to women,” explains White. “There’s a big gap, and it makes me a bit mad that we have people leveraging this gap and talking about it not to actually see policy change and research change, but to sell crap.”

White is part of the Women’s Health Products Working Group (WHPWG) for the Therapeutic Goods Administration (TGA), Australia’s regulatory authority for medical treatments, and she’s noticed a steep rise in so-called health products being marketed to female consumers. Many of these products have a questionable link to actual menopause symptoms—take menopause chocolate, menopause tea, and menopause socks—and instead use menopause branding to sell products at an above-market price, a practice that’s sometimes called meno-washing.

Menopause marketing isn’t just harmful for the women who actually purchase these products, since brand messaging has major influence over mainstream views of menopause. White recognized this after she first started at Jean Hailes and she realized that popular discourse around menopause was eerily similar to what she’d observed as director of the Australian tobacco control program Quit. Just as the tobacco industry lures in customers by exaggerating the safety of their products, she says, “I could just see these companies who were trying to hijack a narrative online.”

When it comes to menopause, marketing campaigns usually make the transition seem worse than it is. After all, brands don’t want to sell products only to the women who actually have severe symptoms—they want to sell to everyone, which means they need women to feel like they need menopause products no matter what.

Uncertainty about which symptoms are actually related to menopause also helps companies boost profits. “There are now, I think, about 200 symptoms ascribed to menopause,” says Hickey—even though only vaginal dryness and vasomotor symptoms like hot flushes have been clearly linked to the stage in scientific research.

“[Menopause] becomes a condition that overwhelms a woman’s life,” adds sociologist Emine Öncüler Yayalar. “It’s become a sort of centrally defining narrative.”

In her research on menopause marketing, Yayalar has noticed two messages that show up again and again: one emphasizes female empowerment, telling women they’re the “main actor” in their menopause, while the other focuses on care, with brands portraying themselves as allies to women who feel confused and alone during this transition.

“It’s kind of interesting,” Yayalar says, “because both of these actually put the burden on the woman.”

As Yayalar’s co-author, marketing researcher Ayse Öncüler, explains, “Empowerment has a positive connotation, but it also means women are expected to educate themselves, to choose correctly, to optimize their bodies.” Meanwhile, she says, messages of care seem to say, “I’m going to accompany you, but you have to make decisions for yourself.”

As much as the massive range of available menopause products makes it seem like women have a choice in how they manage their menopause, there’s only one real solution being offered: when something’s wrong, you buy a product, or take a pill, to fix the problem within yourself.

While hormone replacement therapy (HRT), which replaces the reproductive hormones that decline during menopause, is the primary treatment used for menopausal symptoms, psychiatric drugs are also frequently prescribed—and antidepressants are the most common treatment used for mental health issues in postmenopausal women. Antidepressants may even be used to treat physiological menopause symptoms, like hot flushes, in women who don’t respond well to hormonal treatments.

Because of this, middle-aged women are taking antidepressants at extremely high rates. In the US, for example, women are about 2.5 times more likely to use antidepressants compared with men, and antidepressant use is highest in women in their 40s and 50s. Research also shows that women above the age of 45 are nearly twice as likely to be diagnosed with anxiety disorders, and 1.5 times as likely to be diagnosed with depressive disorders, than their male counterparts. With this, they’re also more likely to receive a prescription for selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs).

This leaves middle-aged women at particularly high risk of the side effects and withdrawal symptoms caused by these drugs. Women of menopausal age are also uniquely vulnerable to certain health complications that antidepressants increase a person’s risk of, such as bone fractures and cardiovascular events.

Even HRT becomes problematic when it’s prescribed as a band-aid for symptoms that don’t actually stem from menopause. “It’s really become increasingly obvious that hormonal treatments work for hot flushes and night sweats,” says Hickey. “That’s pretty much it. But there’s now all these other symptoms that are being ascribed to menopause, and it’s concerning.”

After all, menopause isn’t the biggest issue women are up against during midlife. Instead, women are struggling with the sudden burden of caring for elderly parents while they still have children to look after at home. They face financial pressures as retirement looms closer and gendered ageism that limits their advancement in the workplace.

For many women, this “midlife collision,” as researchers call it, may be the real reason for menopause symptoms. Even physiological symptoms, like hot flushes, are linked with stress and depression, meaning they can’t be blamed on hormones alone. For example, research shows that Black women in the US have more common and long-lasting vasomotor symptoms than their White counterparts, indicating that increased stress from structural racism and discrimination feeds into these symptoms.

Even so, many women still address these issues by purchasing menopause supplements or going to the doctor for treatment. “I think a lot of women are desperately searching for something that helps them manage,” says White. Meanwhile, attention is directed away from the issues that actually need to be addressed.

Not only that, many brands promising to help women actually make their suffering worse by reinforcing the belief that menopause is a time of deterioration. For example, companies often sell menopause skin creams that frame the natural appearance of middle-aged women’s skin as a deficit in need of intervention.

Similarly, some companies sell menopause-friendly accreditations to workplaces, giving them a certification if they complete a training program about how to support employees going through menopause. While these trainings can be valuable for women who need accommodations to help them manage menopause symptoms at work, the training also reinforce the idea that menopause is inherently negative.

“To sell the training package, [companies] have to convince the business that they need it,” White explains.“The rubbish they are pumping out in terms of bad data to try and prove that every woman who hits menopause is now falling off a productivity cliff is disgraceful.”

In reality, middle-aged women are a highly productive subpopulation, but when employers learn to see menopause as a danger to women’s productivity, even those with the best intentions may become biased against middle-aged female employees.

Meanwhile, women themselves suffer when they internalize the belief that their decreasing hormone levels will hurt their productivity. Research shows that women’s earlier expectations about menopause significantly predict their eventual symptoms, along with their severity, later on, meaning that negative expectations about menopause create a kind of self-fulfilling prophecy.

“Some young women have this real fear of what’s going to happen when they get to menopause,” explains White, “and unfortunately, the more concerned you are about menopause, the more likely you are to have problematic symptoms.”

This may happen because these expectations lead to catastrophizing, where a person’s thoughts are biased towards the worst possible outcomes, which can increase focus on sensations associated with a symptom and make them seem more severe. Distress about hot flushes is actually more strongly linked to the frequency of negative thoughts about them than to the frequency of hot flushes themselves, which indicates that cognitive processes related to hot flushes have the greatest influence over how women experience these symptoms.

This phenomenon isn’t limited to menopause—in conditions like chronic pain, catastrophizing has actually been linked with greater pain intensity. Because of this, patients with chronic pain sometimes benefit from cognitive-behavioral therapy (CBT), a form of psychotherapy focused on changing maladaptive thought patterns, which can help decrease catastrophizing. “That doesn’t mean the pain goes away,” says White, “but it means that you learn to manage it emotionally and mentally.”

In the same way, CBT can interrupt women’s apprehensions about menopause and reverse the self-fulfilling prophecy that worsens their experience. “What [CBT] does is help you recognize that you’re having a hot flush and restructure your thinking about it so that it becomes much more manageable,” says White.

Of course, CBT is still solely targeted at the individual and can only have so much impact on women who still live in a society where menopause is pathologized. Cross-cultural research on menopause, while limited, suggests that a society’s beliefs about this stage of life may influence women’s actual symptoms, and symptoms vary widely between cultures. According to some researchers in the field, Hickey says, “There’s so much variation that the only thing that’s common across cultures is that you stop having periods.”

This variation in symptoms may stem from the equally wide variation in cultural beliefs about menopause. For example, White says, Western cultures tend to define women’s worth by their ability to reproduce, making midlife a time of declining value and lost social status. “If you think about the Western culture, we see older women portrayed as bumbling, forgetful, angry,” she says. This view makes menopause something shameful that should be avoided, or at the very least, disguised, feeding into women’s catastrophic thinking and desire to pursue treatments.

However, not every culture views menopause as a medical issue, or even a problem. In China, for example, the phase is referred to as a “second spring,” or a time of rebirth, and evidence suggests that Chinese women have fewer menopause symptoms and lower distress about the transition than women in Western countries.

Meanwhile, in many indigenous cultures, where vasomotor symptoms are less common during menopause, the phase is seen as a natural event where women gain respect from others as they become elders in their communities.

Migration research shows particularly strong evidence that women’s symptoms reflect the views common in their cultures. For example, a 2009 study compared menopause symptoms in Indian women living in Delhi, Indian women who migrated to the UK, and White women in the UK, finding that menopause symptoms were much more strongly linked to country of residence than to ethnicity. In particular, women who migrated to the UK were more likely to have hot flushes, which are more common in the UK where menopause is heavily medicalized, than women who stayed living in India.

Of course, this doesn’t mean it’s harmful to acknowledge that some women do have symptoms during menopause—in fact, many women in cultures where menopause is less medicalized face barriers to speaking up or accessing care when they do have symptoms. Instead, researchers like White and Hickey emphasize a need for education campaigns that make women aware of possible symptoms without implying that menopause itself is a disease. As White puts it, “We need to be prepared, but not scared.”

Currently, accessible information about menopause is often shaped by commercial interests, and many educational events are sponsored by pharmaceutical companies looking to increase their sales. Because of this, newer educational resources need to be free of industry influence, which can lead to a slant towards catastrophic narratives about the transition.

Further research is also needed to improve the quality of these resources. “We could really start by being consistent about what we say,” explains Hickey. “Even trusted sites and government sites, they tell you different things about what symptoms you might get and what the treatments are.” This not only makes it harder for women to learn about menopause but can also draw them towards commercially biased sources, which may present menopause in a more clear-cut way.

Most importantly, education campaigns can make room for positive menopause experiences. “It would be great for a lot of people to realize there are some massive positives around not having to worry about contraception, not having to worry about periods,” says White. “As one lady said to me, ‘I wear white pants all the time now.’”

Presenting menopause as something that leads to a huge range of experiences could help prevent distress at middle age from being treated as an inevitable result of a woman’s physiology that requires medical intervention. “[Menopause] is a little bit like pregnancy,” Hickey explains. “It’s a normal thing, and usually it’s fine. Sometimes it goes wrong, and when it goes wrong, that person needs help. We grasp that concept for pregnancy but don’t really grasp it with menopause.”

So when women visit Jean Hailes’ clinics worried about perimenopause symptoms, White doesn’t want this concern to be dismissed—she just doesn’t want perimenopause to be used as an easy answer for symptoms that could have any number of causes.

“It’s the structural things we need to change, not just taking a pill that’s suddenly going to make everything all right,” she says. “We actually have to do some hard work around changing some social and cultural structures.”

The post Inside the Hot Flush Gold Rush: The Medicalization of Menopause Spreads to Perimenopause appeared first on Mad In America.

 

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