What Happens When We Pathologise Menopause?

Menopause is a natural transition in a woman’s life that signifies the end of her fertile years and the beginning of a more empowering time of life. However, in Western culture, perimenopause is often medicalised and framed as a hormone disorder or imbalance requiring pharmaceutical intervention. This viewpoint of menopause as a hormone deficiency syndrome or a medical imbalance that needs to be ‘fixed’ categorises menopause as a ‘condition’ which should be feared, endured and battled.

This conversion of the natural transition of menopause into a medical disease or disorder is pathologisation. While medical intervention is valuable where a disease process, injury or disorder lies at the root cause of a health problem, pathologisation creates far-reaching consequences for women, society and the medical system itself.

But what happens when we pathologise menopause? In this article, I will explore the personal, social and medical impact of pathologising perimenopause as a hormone disorder. 

The medicalisation of a natural transition

To gain a little perspective on the medicalisation of menopause, let’s look at some other natural transitions that occur. Life stages such as puberty and pregnancy are still seen as natural stages. Although you may need some medical intervention during these times, you won’t use pharmaceutical medicine to ‘fix’ the imbalance; it’s understood that they are natural processes. During these times, we stand by, observe what is happening with our body and support the body’s natural healing process.

On the other hand, menopause, another natural transition, if viewed as a disease pathology or a hormonal imbalance, pharmaceutical intervention, such as HRT (MHT), antidepressants or other medications, is prescribed to ‘correct’ the imbalance and to fix the problem. 

While the use of pharmaceutical medications can offer some vital relief for some women, this perspective reduces menopause to a set of symptoms and risks, rather than a natural life process.

Emotional and psychological consequences

Pathologising menopause can lead to significant emotional distress, primarily when we are told, either directly or indirectly, that menopause is associated with deficiency and decline of our femininity, our youth, our fertility, our desirability and our emotional stability.

This perspective of decline rather than the empowering script that we should be reading from, can lead to feelings of shame, inadequacy and anxiety. These reactive emotions can add fuel to the fire of pathologising menopause as a tumultuous and ‘hysterical’ condition.

These narratives can amplify fear and dread (of midlife, menopause and natural aging), with women often overlooking the empowering opportunity of menopause and instead seeing menopause as something that needs to be denied, avoided or ‘fixed’.

Furthermore, some women report feeling misunderstood or dismissed by primary healthcare providers when discussing health concerns during midlife. Symptoms and sensations may not fit into a diagnosable medical ‘box’, especially if the sensations are emotional, social, or, dare I say it, existential. 

Common medical retorts of “it’s all in your head”, or “you’re imagining things”, or “you’re just depressed” undermine trust, discourage open and honest communication and further derail perimenopause into a marginalised medical condition.

Social and cultural impact

Culture plays a huge role in how we and society view menopause. Influences from the collective unconscious and social media shape our beliefs about perimenopause. Western society values fertility, youth, and a slender appearance over wisdom and knowledge. In these cultures, a woman’s value diminishes because she is no longer fertile, youthful-looking, or fitting into the Western social construct of femininity and beauty.

Pathologising menopause further feeds this cultural stigma, suggesting that women of a certain age are unwell, incomplete or no longer valuable in society. This kind of thinking can lead to discrimination in the workplace, in relationships and within women themselves.

How we frame the menopausal transition can influence our perspective of our experiences. In some Eastern cultures, menopause brings with it wisdom, respect and for many women, a feeling of liberation from menstruation and fears of pregnancy.  

The healthcare system’s response

Medicalisation of menopause, again, especially in Western cultures, brings with it an overreliance on pharmaceutical intervention and HRT. This reductionistic approach completely misses the opportunity for expansion and empowerment that this life stage symbolises. This approach will often overlook the value of simple and natural methods to support the body’s healing process, including physical activity, meditation, nutrition and herbal medicine.

Pathologising menopause in conventional medicine further leads to the sequestering of funding from these more holistic and supportive modalities into pharmaceutical ‘cures’ for a perceived hormonal deficiency. 

Furthermore, those in marginalised communities may be overlooked and may face even greater barriers to respectful and informative health care. Those women who do not fit into the classic conventional model of menopause may be overlooked or misdiagnosed, leading to poor outcomes and incorrect prescribing.

The risks of over-treatment

The natural flow of pathologising menopause commonly leads to over-treatment with pharmaceutical medications. Where discomfort is experienced, conventional medicine is pushed to alleviate pain at all costs, leading to prescriptions of synthetic hormones as a default option for the ‘treatment’ of a natural transition.

Using HRT as the gold standard for menopause fails to consider the potential side effects of excess synthetic hormones in the body. And viewing menopause as a disease process or a hormone deficiency then leads to further exploitation by manufacturers of hormone remedies, and magical potions that alleviate the symptoms of menopause.

Re-framing the narrative

So, how would things look if we took a different perspective and viewed (peri)menopause as the natural transition that it is? Firstly, we would see menopause in a similar way to puberty and pregnancy, as natural, empowering, and exciting times in our lives. Menopause involves many hormonal, physical, and emotional changes, but it doesn’t necessarily mean these are a pathology.

A more empowering narrative for menopause would:

• Centre personal agency: Allow women the authority to make choices with their health, with adequate education, information and modalities to support natural healing.
• Normalise diversity: Acknowledge that each woman’s journey through perimenopause is unique and diverse, requiring individualised support at each transition stage.
• Include emotional well-being: Prioritise mental and emotional well-being as much as physical health, acknowledging the challenges, changes, and opportunities within the menopausal transition.
• Value wisdom and maturity: Focus on the power and strength of age and experience. Respect and value the accelerated emotional growth that comes with maturing naturally into menopause.
• Provide equitable care: Ensure that all women, regardless of background, have access to respectful, educated and inclusive support for the natural transition of menopause.

The role of education and advocacy

One of the most potent tools for dismantling the pathologising of menopause is accurate and holistic education on the transition of menopause. Providing balanced and thought-provoking information to younger generations can help to alleviate fears and misunderstandings before signs of perimenopause begin to appear.

Opening the door to discussions around women’s menstrual health, emotional challenges, and social implications of perimenopause can remove the taboo and secrecy of menopause. This means integrating menopause education into school education, workplaces and creating awareness to alleviate the stigma of menopause as a pathology.

In conclusion

Menopause is not a malfunction or a disorder; it is a natural transition that provides a crossroads to empowerment and deepened self-awareness. Pathologising this natural transition limits our understanding and alienates those going through it.

While perimenopause can be challenging, it can also be an opportunity for growth, reflection, and reinvention. By embracing menopause with a more inclusive, compassionate, and holistic perspective, we can change how we view it – not as a disease process but as a life transition to navigate with grace and dignity.