Intended for healthcare professionals

Analysis

Normalising menopause

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj-2021-069369 (Published 15 June 2022) Cite this as: BMJ 2022;377:e069369
  1. Martha Hickey, obstetrician-gynaecologist1,
  2. Myra S Hunter, clinical health psychologist2,
  3. Nanette Santoro, obstetrician-gynaecologist3,
  4. Jane Ussher, critical health psychologist4
  1. 1Department of Obstetrics and Gynaecology, Royal Women’s Hospital, Victoria, Australia
  2. 2Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
  3. 3Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, USA
  4. 4Translational Health Research Institute and School of Medicine, Western Sydney University, New South Wales, Australia
  1. Correspondence to: M Hickey hickeym{at}unimelb.edu.au

Martha Hickey and colleagues argue that social and cultural attitudes contribute to the varied experience of menopause and that medicalisation fuels negative perceptions

Menopause is a natural event for half of humankind. The term “menopause” denotes the final menstrual period but is often used to describe the menopause transition, starting with changes in the menstrual cycle and finishing one year after the final menstrual period. While media attention in in the UK may give the impression that growing numbers of women are struggling to cope with menopausal symptoms and are seeking hormonal treatment,1 there is no universal experience and most women prefer not to take medication unless their symptoms are severe.2 In fact, socioeconomic status, education level, and social and cultural attitudes to menopause act with biological factors such as hormonal changes, smoking, diet, and body mass index to determine the experience of menopause, including the nature and severity of symptoms.

We argue that medicalisation of menopause risks collapsing the wide range of experiences at the average age associated with this natural process into a narrowly defined disease requiring treatment. Medicalisation tends to emphasise the negative aspects of menopause and, while effective treatments are important for those with troublesome symptoms, medicalisation may increase women’s anxiety and apprehension about this natural life stage. Changing the narrative by normalising menopause and emphasising positive or neutral aspects such as freedom from menstruation, pregnancy, and contraception, together with information about managing troublesome symptoms might empower women to manage menopause with greater confidence. People with functioning ovaries who do not identify as female will also experience menopause if they do not take cross gender hormones. We use the terms women and women’s health to encompass all these individuals.

No universal menopause experience

In high income countries, menopause usually occurs at around age 51 years, although the range …

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