Is Menopause Really Over-Medicalized or Are We Just Overthinking It

Out there in what I call the "menoverse," there are two factions. Faction one thinks treating symptoms with pharmaceutical interventions like MHT is wrong and against the natural order of things. Faction two feels that women should have the option to treat or not treat symptoms to whatever extent they prefer.

While both camps understand menopause to be "natural," there has been an increase in medical discussions and products designed to alleviate symptoms, and the folks in faction number one seem to believe menopause is becoming "over-medicalized." But is that true, or are we just overthinking this phase? Let's explore!

Understanding Menopause

Menopause marks the end of a woman’s reproductive years, typically between 45 and 55. This phase is accompanied by various physical and emotional symptoms resulting from hormonal changes, such as hot flashes, night sweats, mood swings, and changes in libido. For instance, nearly 75% of women report experiencing hot flashes during this time, and research indicates that more than 50% struggle with sleep disturbances due to menopausal symptoms. Each woman's experience is unique, reflecting different backgrounds, lifestyles, and health conditions.

While menopause is a natural biological process, its symptoms can be distressing and may require attention. The real question is: How much medical intervention is necessary?

The Rise of Medical Solutions

In recent years, the array of treatments available for menopausal symptoms has expanded significantly. Menopause Hormone Therapy (MHT) is one prominent option that many women consider. MHT aims to alleviate uncomfortable symptoms by restoring estrogen and progesterone levels. It should be noted that those levels will never reach a woman's maximum level that she had during her most fertile years.

Beyond MHT, numerous other products have come to market, such as the non-hormonal treatment Veozah for hot flashes and various SSRIs (Selective Serotonin Reuptake Inhibitors). However, recently, more advanced therapies have come to light as featured in April 30th's National Geographic article, Could this be the end of menopause we know it?

A long time ago, I covered some of these treatments explored in Rachel Gross's book Vagina Obscura. You can even listen to an interview with her on the CTD podcast here. However, much of this work was experimental in the book, but according to the Nat Geo article, it sounds like some of these treatments are coming to market soon.

One of these treatments is a drug called Rapamycin. Excerpt from the Nat Geo article below:

"Rapamycin is already FDA-approved for a range of use-cases unrelated to ovarian aging, including post-renal transplantation, and is widely available, intensively studied, and has an excellent safety profile according to Williams. ​If rapamycin sounds familiar it’s also because the drug has become popular among “anti-agers” after being touted by author and doctor Peter Attia for its purported longevity and health benefits, but more research is needed to definitively prove this link."

"Rapamycin works by inhibiting a protein called mTOR, a key component of the cellular pathway involved in aging and metabolic regulation. ​​​​In preclinical mouse and cell systems models, inhibiting ​this​ activity extends ovarian lifespan, ​which ​preserv​es​ egg quantity and quality, Williams explains. To go a layer deeper, Williams ​theorizes that the drug will slow down the rate at which a woman’s eggs turn over every month. Instead of losing dozens every month, a woman might only lose 10, for example, while keeping the other eggs in her reserve. ...the trick is to start taking the drug before menopause, as it cannot bring eggs back. It most likely wouldn’t work for postmenopausal women."

In other words, this drug is meant to reduce the number of eggs released during your period, thus extending your egg reserve later in life and delaying or even preventing menopause altogether.

Folks have big feelings about this, and I get it.

On one hand, you might think, "We don't need to prevent it; it's natural." On the other hand, you might be like, "Cool. That means better bone density and (likely) a longer life in addition to a reduction in menopausal symptoms."

The Cultural Impact on Menopause Perception

The way menopause is portrayed in culture significantly influences how women view this life stage. Historically, it has been framed as a condition contributing to stigma and discomfort. A recent survey revealed that more than 60% of women feel embarrassed discussing menopause openly, fearing negative perceptions.

In many societies, the dialogue surrounding menopause often emphasizes symptoms and solutions instead of fostering empowerment and support. This focus can create the impression that women must tackle menopause as a medical problem rather than a natural transition deserving acceptance.

Over-Medicalization or Overthinking?

It’s easy to confuse the availability of medical options with their necessity. Just because various treatments are available doesn’t mean every woman needs or has to take them.

Critics argue that the medical community sometimes leans too heavily on prescribing treatments without considering holistic and lifestyle approaches. However, according to PubMed:

"In this serial cross-sectional study that included 13 048 postmenopausal women, the estimated prevalence of MHT use declined from 26.9% to 4.7% over 2 decades, with the greatest declines observed among women aged 52 years to younger than 65 years. Women of racial and ethnic minority groups had lower prevalence of MHT use compared to non-Hispanic White women."

There has been a decrease in the use of MHT, so I'm not sure how this can be viewed as "over-medicalization." Furthermore, any menopause-literate practitioner will tell you that even MHT is not a magic bullet and is just a part of the treatment, with lifestyle and nutrition being the other big pieces of the puzzle.

It is indisputable that many women find real relief through pharmaceutical interventions. The challenge lies in identifying when and if treatment is warranted, but making people feel bad for their choices is just plain sh*tty.

Seeking Balance

Instead of categorizing menopause treatment as one thing or another, I think we all need to be reminded that asking women to suffer through pain and discomfort that can be treated is patriarchal. This is where I bring up the controversy (again) of IUD insertion without painkillers as a great example. What in the actual H, E double hockey sticks?!

I genuinely wish there were more cultural allowances, rituals, and kumbaya moments around these big life transitions like menstruation, pregnancy, and menopause, but this is not the world we live in—at least not yet.

So, in the meantime, can it not be both? Can we not only promote a right to choose what treatment works best or no treatment at all, while working to pass legislation for menopause accommodations in the workplace, increased funding for menopause research, better education, and better community outreach, ritual, and connection?

I think we can. I believe we can, but what I do NOT support is limiting a woman's bodily autonomy in ANY form, be it abortion, birth control, or menopause treatment.

You do you is my motto, and I think folks who feel otherwise really need to look inward and ask themselves why they CARE that other women are using medicine for menopause.

I'd love to hear how you feel about this in the comments!