The Language Of Menopause

Women’s language vs medical language

The need to reclaim and construct language

Women’s language vs medical language

Language shapes our thinking. Proponents of the medicalized perspective have constructed the language used in discussing menopause and midlife women to reflect their perspective. This language has so infiltrated the discourse that even those who disagree with this view tend to use medicalized terms. In order to reclaim menopause, we need to reclaim the language and to develop new language to reflect more accurately our own experiences.

Let’s begin with the word “menopause”. Most women see menopause as a transitional process. It is the time when we move from our potentially reproductive years to our post-reproductive years. For about 35 years, high levels of fluctuating hormones are necessary for reproduction. During the transitional phase, the menopausal years, the hormonal levels are changing, some are increasing while other are decreasing. The most common sign that this process is beginning is a change in menstrual patterns. Cycles can be shorter or longer in length; the flow can be lighter or heavier. During this process, women frequently refer to themselves as menopausal. In one community study, the Massachusetts Women’s Health Study,1women’s answers to questions about their menopause reflected this: “just beginning” “in the middle”, “near the end”, and “all through”.

Proponents of the medical perspective define menopause as a specific event, the final menstrual period (FMP) which can only be ascertained retrospectively. According to this perspective, a woman does not know whether she has reached menopause until she is without her period for 12 months. Then she knows that 12 months ago, she reached menopause. Menopause is considered equivalent to the FMP. Physicians sometimes perform blood tests to “diagnose” menopause.

Perimenopause is defined as the period of time that starts when the menstrual cycle begins to change and ends with the FMP. So a woman who defines herself as menopausal is defined as perimenopausal according to the medical perspective. Another term, no longer widely used, is the “climacteric”. It corresponds roughly with the perimenopause, but is thought to begin much earlier.

A woman who has had her uterus removed but not her ovaries has reached menopause by one definition (she has had her FMP) but actually may not have hormonal changes. Other women, however, do have some hormonal changes after a hysterectomy. Why this happens is not well understood. One theory is that when a woman has a hysterectomy, sometimes the blood supply to the ovaries is disrupted causing hormonal changes. Another theory, this one proposed by Susan Love,2 is that the uterus may produce some yet-undiscovered hormones that provide feedback to the ovaries. When the uterus is removed, this feedback is disrupted.

Physicians refer to the removal of both ovaries as a “surgical menopause” and radiation treatment or chemotherapy which prevents the ovaries from functioning, as a “medical menopause”. Neither resembles a (natural) menopause uninterrupted by medical intervention. In these procedures, there is an abrupt stop in ovarian hormones. During (natural) menopause, the hormones are decreased gradually. After (natural) menopause is completed, a woman’s ovaries continue to produce hormones long after her FMP.

In addition to constructing menopause as a deficiency disease, it has become commonplace to define women by their hormonal status (i.e., premenopausal, perimenopausal and postmenopausal women rather than young, midlife and older women, as we might refer to similarly aged men). Consistent with the medicalized view of menopause, women who are not taking hormones during or after menopause are increasingly labeled as “untreated”, “estrogen-deficient” or “estrogen-deprived” women.

The term “hormone replacement therapy” implies that the hormones taken by midlife and older women are the same as those naturally secreted by menstruating women and that it is therapeutic to replace them. The medical profession also uses the term “natural” to refer to Premarin, the most commonly prescribed estrogen in the United States for women around or after menopause.

Estrogen use is a drug treatment, the typical dose and type prescribed does not approximate the type and pattern of hormones in menstruating women. Premarin is extracted from the urine of pregnant mares, and while this estrogen is natural to pregnant horses it is, of course, most unnatural inside a woman’s body. The words “replacement” and “natural” however, may make us feel estrogen is safe and therefore acceptable to use. Some medical writers express their disagreement with these now-accepted ways of referring to hormones by using terms such as “hormone substitution therapy”, “non contraceptive hormones”, “hormonal supplementation”, or simply “hormonal user” to refer to women taking hormones or by putting the term “natural” in quotes.

1McKinlay, S.M., et al. “The Normal Menopause Transition” Am J Hum Biol, 1992; 4: 37-46
2 Susan Love’s Hormone Book , p177