It happens to every woman, naturally, but doctors sometimes have to get involved. The menopause is not yet `medicalised'
Tuesday 18 February 1997
My partner Dr Ellen Grant had devoted much of her life to criticising the prescription of sex hormones because they "disrupt the balance of our bodies' vital nutrients, rob us of our protective immunity and threaten our genetic integrity". She has fine medical credentials and speaks with a conviction I find unsettling, not least because I prescribe these hormones for all the conditions she says I shouldn't. It wasn't going to be an easy partnership.
Opposing the motion was Professor David Purdie, a consultant gynaecologist, and Angela Rippon. The chair was a gynaecologist and the audience consisted of, um, gynaecologists, members of the British Menopause Society and employees of an HRT manufacturer. I felt like a Chelsea fan up the wrong end of Old Trafford.
The thrust of Professor Purdie's argument was to emphasise the benefits that medicalisation has brought women over the centuries (eg they tend not to bleed to death in childbirth these days) and that HRT should rank alongside these great achievements. Thanks to medicine, women are now likely to spend 40 per cent of their lives post-menopause, and it will take another medical advance to maximise the quality of life of many (but not all) of them. There are oestrogen receptors all over the body, and a daily oestrogen fix in those who need it has benefits for bone, heart, arteries, mental and nervous function which greatly outweigh the increased risks. End of story.
Dr Grant begged to differ. "The menopause is a natural event in the life of a woman. So why medicalise it?" Good point. "Women and doctors have been brainwashed into believing that the menopause heralds an oestrogen deficiency disease. This is physiological nonsense. Do young girls have an oestrogen deficiency disease before puberty?"
Every drug has the potential to do harm as well as good, but Dr Grant believes sex hormone prescribing is almost exclusively harmful. "The time course of the breast cancer epidemic in developed countries correlates uncomfortably well with the changes in sex hormone prescribing." Angela Rippon wanted women to have informed choice. Hand over the evidence and let individual women decide if HRT was for them. You can't really argue with that unless you believe women aren't capable of making rational decisions - and I know some gynaecologists who do. Dr Grant is convinced that much of the evidence on which the benefits of HRT are founded is flawed and so rational decisions are impossible. Professor Purdie was quick to poo- poo this, but admitted that a large controlled trial of HRT versus placebo had yet to be completed. This is the gold standard test to check if a treatment works or not but it's very expensive and there is so much hype about HRT that one such trial in America is having difficulty recruiting volunteers because no one wants to risk taking the placebo.
For me, the debate hinged on the word medicalisation. "It doesn't mean offering women medical choices but rather making it very difficult for women to have anything other than a medical choice. Take childbirth: 98 per cent of women have hospital births even though low risk deliveries are just as safe at home. Yet it's impossible for many women to get home births because we've all been brainwashed into believing hospital is safer. If the menopause was truly medicalised, women wouldn't be allowed to have it at home. They'd be strapped to a hospital bed with their legs in stirrups until the flushes had passed." Somebody laughed or choked. "And medicalising the menopause is far more than HRT. A gynaecologist in this room offered his wife a hysterectomy and ovary removal for her 40th birthday." Nobody laughed. "Eighty per cent of the wives of American gynaecologists have had their wombs removed. Is this a good thing or are they just married to scalpel-happy chaps? If you're going to whip out the womb and ovaries because they're redundant and potentially cancerous, why not the tongue and ears? No one listens or talks to you when you're old.
"And why do men become gynaecologists anyway? You don't get women queuing up to be urologists saying, `Surround me by dribbly willies, yes please.' Medicalisation of women's health means men controlling and making decisions for women. Would a woman have come up with the idea of allowing pensioners to have babies? No, it's a man's experiment and it stinks. Imagine your grandmother in labour, and for that alone, I urge you to deplore medicalisation of the menopause." I was absolutely brilliant and completely irrelevant. We were thrashed. As for HRT, I heartily recommend it if you are at particular risk of brittle bone disease. For anything else, it's up to you.
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