Intervention and (Re)Invention for Women in Menopause: Cultural Norms, Hormone Therapy and Female Subjectivity

Abstract

Using Michel Foucault’s genealogical approach I analyze the development and promotion of menopausal hormone therapy (MHT). The post-structural genealogy identifies important scientific and social junctures that drove the administration and consumption of the therapy. Findings from randomized controlled trials a decade ago revealed MHT to have greater risks for women than had been known and provided the impetus for this study.

Interviews with fifteen women were conducted in 2007. Nine women were experiencing a natural menopause, two were premenopausal and four had had a hysterectomy although retained their ovaries. Analysis of semi-structured interviews ensued in reference to the following published texts: a popular medical textbook, the US Food and Drug Administration’s (FDA) publications on MHT, and lastly, the Boston Women’s Health Book Collective’s (BWHBC) text Our Bodies, Ourselves: Menopause. Three major discourses in relation to menopause and MHT were isolated: medical and biomedical-science, public health, and feminist discourses of women’s health advocacy.

Analysis was guided by four analytical features using a Foucauldian-inspired approach. The four features comprised the concept of production of beliefs; the significance of sign systems; the nexus of power/knowledge and the discursive practices that govern the conduct of individuals; and lastly, the alignment of the self to discourses and subjectivity.

Deconstruction of the category of the climacteric revealed that medical knowledge has not exclusively occupied a neutral scientific position. Rather, medical construction of the menopause has been influenced by misogyny and ageism, and by the production and reproduction of an intractable dichotomy of the normal and abnormal, leading to menopause being equated with deficiency and thus disease.

Furthermore, truth itself is contested. This thesis finds that Foucault’s expression “games of truth” is recognizable in the contestation, claim and counterclaims about the merits of MHT. Public health and preventative discourses were found to ground the wholesale promotion of MHT to well women, alongside commercial imperatives that drove productive relationships between manufacturers and the medical fraternity.

The participants disclosed varying responses and reactions to the complexity that pervaded information on the safety and efficacy of MHT. Whilst women aligned themselves with elements of discourse from all three organizing categories (medical, public health and women’s health advocacy), they also assumed courses of resistance often framed as privileging aspirations to enhance their “quality of life.”

The persistent disputation of truth about the science of hormones, normality and disease, methodological features in research, questions of commercialization, safety and efficacy of therapies, and the conceptualization of mid-life and ageing women were spheres of interest that emerged. Subjectivity was found to be contested. The participants revealed they engaged in self-work to achieve the balance they sought in life, often in a climate of negation and disregard of their interests by those who advised them. These women acted as their own gate-keeper to enhance wellbeing and either resisted or revealed awareness of negative female stereotypes.