Why is there so much confusion around how to treat women in menopause? Well, I would postulate that the confusion has been building for some time now. You see if you don't look back on history and the thinking then you are in danger of repeating the outcomes of the past. Isn't that true of anything? And I would dare say that doing the same thing over and over again is the very definition of INSANITY or can I say, making someone re-live the mistakes of the past over and over again could be considered making THEM go insane. For centuries women have been saying that there is another stage in their development that they are experiencing but have been told for years there is nothing to going on. From the 1700s until now women have been told to keep moving along the highway of life that there is "nothing to see", "move along," (a form of gaslighting of sorts). But women for millennia have known that there is another coming of age. They have talked about it in whispers, declared it out loud, and even exchanged entire non-verbal conversations around what I have deemed The Other PMS TM. So what has brought us to this precipice in our existence where women are speaking out and engaging in what feels like the swelling of a title wave of change but are engulfed in a sea of confusion more than ever before? Well, I have a theory. In my opinion, the confusion comes from the historical dogma in which women and their health were/are classified.
Reason #1 The 1700s--Hippocrates
In the 1700s, one of the prevailing thoughts around women’s health was that since women’s periods stopped “all of a sudden”, they must be a weaker spiritual vessel. You see as far as science and society knew there were no equivalent physiological disruptions in a man’s body. So this must be a spiritual or mental flaw or weakness. Now due to the chemical and physiological changes that women were experiencing they were not acting like themselves anymore. And women were labeled to be in a state of “hysteria”. And because this was a flaw in mind and character there was no medical investigation to be done.
Reason #2 The 1800's--Dr. Edward Tilt
In the 1800s, the term menopause was finally coined. Even though women had a name for what they were experiencing they were still left with no solution that would help them feel better. The belief that menopause was linked to the concept of it being associated with “evil” was strongly held. The belief began to morph into the teaching that menopause was linked to…INSANITY. A Medical textbook published in 1887 stated the following:
“The ovaries, after long years of service, have not the ability of retiring in graceful old age, but become irritated, transmit these irritations to the abdominal ganglia, which in turn transmit the irritation to the brain, producing disturbances in the cerebral tissue exhibiting themselves in extreme nervousness or an outburst of actual INSANITY.” Dr. Edward Tilt founder of the London Obstetric Society argued that the only way to treat this type of madness was to remove the offending organ…. perform a hysterectomy. If you couldn't prescribe a hysterectomy other treatment options were, giving sedatives, opium, vaginal injections of lead, or pulverized cow’s ovaries.
Reason #3 Early 1900's--Sigmund Freud
At the turn of the century the theory that menopause necrosis was taking hold. Sigmond Freud’s input into the analysis of women in menopause was that they were unproductive and useless members of society. Other psychoanalysts of the time touted their analysis of menopause. A prominent female psychoanalyst, Helen Deutsch postulated that menopause was a normal stage of human female development. However, she went on to share her beliefs that menopause was traumatic for EVERY woman. Ultimately the beliefs at this time around menopause were one of loss. Loss of vitality, loss of youth, loss of self-esteem, and loss of fertility. The working theory at the turn of the century was that menopause was a season of loss. The teaching was that menopause was a physical response to an issue of loss.
Reason #4 1960's--Dr. Robert Wilson
By the 1960s menopause was portrayed as a time in a woman’s life where she experienced some type of deficiency. The overwhelming consensus of that time was that this deficiency also resulted in a loss of femininity. This deficiency caused society to look at women as “living decay”. In an attempt to combine Dr. Robert Wilson's new physical theory of menopause with Freud’s existing psychological theory an emerging belief began to take root.
The new belief was this deficiency was affecting their character! And the only way women could be "cured" was to give them back what they were lacking.
What specifically were women lacking? What did they have that men didn’t? This is the time when scientists discovered estrogen. This became known as..."The Fountain of Youth!”
Reason #5 1970s-21st century--WHI Study Halted
If there were a way I could describe what happened with women's health in this century, it would be as if dialing a trusted friend and finding out their number has been disconnected or is no longer in service (how many of you all remember that recording? LOL, We are telling on ourselves aren't we?), but I digress. I feel that in 2002 when the study results came out we (doctors), were not given a backup number, phone a friend, or any type of lifeline. We were left to swim on our own! In the beginning, it was mayhem.
Women were getting snatched off of their HRT left right and center. Doctors were scared out of their minds and were feeling helpless because we didn't have the "band-aid" that we could give to solve a problem. What were we to do?
This study was supposed to be a landmark study. Before 1991 little research focused on health issues unique to or common in women. This study was going to look at chronic disease and prevention in “mature” women. Conditions such as coronary heart disease, cancer, and osteoporosis were going to be studied.
Let me set the scene. This initiative had three parts to it: 1) clinical trial component, 2) observational study, and. 3) community prevention study. There were a total of 40 clinical centers with 26,046 underrepresented minority women and 135,762 white women ages 50-79. The study was going to run for 8.5 years but as you will discover was cut short at 5.2 years.
The clinical trial component had 3 sub trials: hormone replacement (HRT), dietary modification trial, and Calcium/Vitamin D supplementation trial. The HRT trial wanted to answer the question: does long-term HRT with conjugated equine estrogen (CEE) and medroxyprogesterone acetate reduce coronary heart disease and osteoporosis without increasing breast cancer risk. The answer was a resounding NO! And what happened next was terrible. Medicine went into radio silence when it came to women's health. We got real quiet even when the research continued and we discovered bioidentical hormones. We stayed quiet as we started hearing women talk about waking up in a body they didn't recognize. So we told them to eat less and move more. We stayed quiet when women were saying my body is betraying me and I'm doing my best. We kept gaslighting women and telling them it was all in their heads and for that, I say, "I'm truly sorry".
Women and those who champion women's health need to continue to raise our voices so that we are heard. We need to continue having conversations among ourselves when we discover another change that occurs when we reach perimenopause and menopause. We need to continue to say we will not be silenced or discarded! And we need to continue to educate women for generations to come.