This decades-old debate has just resurfaced, causing heated controversy in the medical world, with both sides claiming the best interests of patients.
The British Journal of Medicine, one of the most prestigious medical journals, started the controversy by publishing a very critical article in mid-June about a “medicalization“Excessive menopause.
“By focusing solely on the symptoms, we risk fueling women’s fears“, judge the authors around the Australian gynecologist Martha Hickey.
On the contrary, they call for itnormalize menopauseThey emphasize the positive aspects of this time when a woman, usually in her late 50s, permanently loses her fertility, such as the comfort of no longer menstruating.
emphasis on character”naturally” of menopause, the authors focus on one goal: hormone treatments given to women to counteract certain effects, such as hot flashes or insomnia.
Without wanting to do without these treatments entirely, researchers accuse them of emphasizing menopause with the idea of a “Waste” which could be reversed. They feel they have received too much praise from the media and scientific literature, which greatly benefits the pharmaceutical industry.
“Menopause is a ‘natural’ phase of aging”
This critique is, more broadly, part of a movement that insists on the social aspect of menopause and believes that its effects are influenced as much by this cultural context as by purely physiological processes.
But this vision is not uniform. Immediately after its publication, the article drew strong criticism from other menopause experts, who denounced a counterproductive position for women’s well-being.
The item “is spreading a very dangerous notion that since menopause is a “natural” phase of aging, women should avoid medical treatments“, several dozen doctors, led by the British gynecologist Louise Newson, regret in a letter to the BMJ.
They believe such a speech would likely minimize the suffering of many women who would be denied the means to calm them down.
This controversy takes place in a specific media context. Several feminist organizations recently ran a campaign in the UK to denounce the difficult access to these treatments.
But it’s also the new installment of a much older debate about their risks. For example, they are associated with a slightly higher incidence of breast cancer.
“We certainly covered too much‘ admits French gynecologist Anne Gompel to AFP.Maybe because the side effects were badly rated, maybe because of the marketing of the pharmaceutical companies“.
Only, according to them, this situation goes back more than twenty years and changed drastically with the publication of studies in the early 2000s that highlighted the risks of these treatments.
“There has been an undermedicalization in recent years“
Since then, the scientific literature has grown that puts into perspective certain biases in these studies without being able to say in detail to what extent the benefits of the treatments outweigh the risks.
In 2017, the Cochrane website – a database that summarizes the body of knowledge and is a reference in the medical world – concluded that hormone treatments are appropriate when menopause is having an impact.unbearable“.
But where should the threshold of the unbearable lie? This is the difficulty for doctors who, after lacking the ability to judge, now tend to be overly cautious, says Ms. Gompel.
The French gynaecologist, who admits that the BMJ article rightly deplores the negative stereotypes surrounding menopause, therefore thinks it wrong to invoke excessive medicalization.
On the other hand, “in recent years there has been an undermedicalization“, she regrets, even considering that the risks of the treatments marketed in France are lower than in Anglo-Saxon countries.
“There are women who are disastrously embarrassed at this time and are having a terrible time in France at the moment finding someone to treat them.‘ she reports, adding that she has received similar feedback from other countries.