What’s hormones got to do with it? The medicalization of menopause in postwar America

Pavane L. Gorrepati
Iowa City, Iowa, USA

 

An example of one of the many articles and advertisements published during this time in the Ladies’ Home Journal promulgating the use of hormone replacement therapy. Scott, J. (1946, 03). YOU NEED NOT FEAR THE MENOPAUSE. Ladies’ Home Journal, 63, 33-191. Retrieved from https://search.proquest.com/docview/1866674008?accountid=15172

Introduction

From menstruation to menopause, there appears to be a deliberate and constant medicalization of the stages of a woman’s life. Menopause, a biological process every woman experiences, has been cast in a negative light, a time to be wary rather than to be celebrated. This has led the West to a move to counteract the decline in reproductive hormones by exogenously replacing the decreased estrogen in a woman’s body.1 In the 1930s, the development of pharmaceutical estrogen created a new treatment for this “deficiency” for women in the form of hormone replacement therapy (HRT). Synthetic estrogen would become one of the most popular drugs by the 1990s.2

Although physicians still primarily relied on reassuring patients that their symptoms were a natural part of aging and would subside, they slowly began incorporating into their practice the temporary use of hormones, such as diethylstilbestrol (DES), if a woman’s symptoms were unbearable.3 Now that an effective treatment was available, women sought relief from their symptoms – creating a market for pharmaceutical companies and physicians. Women would frequently ask for such treatments because of a perception that hormones were “miracles” in alleviating symptoms and held the key to “maintaining [their] youthfulness.”4 The literature and popular media frequently propagated this notion during the mid-twentieth century.

 

Media Messages

Pharmaceutical companies gained the most from the popularization of hormone replacement therapy. They helped to promulgate the message of the benefits of HRT to physicians. Advertisements for Ayerst’s Premarin, a form of synthetic estrogen, often appeared in medical journals such as Obstetrics and Gynecology and the Journal of the American Medical Association. Often the advertisements featured an attractive, youthful woman. One such advertisement also featured the caption, “Help keep her this way.”5 Advertising to physicians in medical journals was a tactic drug companies used to sell their products. Pamphlets from pharmaceutical companies in doctors’ offices and women’s magazines were all echoing a message that estrogen and hormones were saviors against menopause. Magazine articles and other media sources often conveyed information about menopause and hormone replacement therapy.

The first discussion of menopause in Ladies’ Home Journal or Good Housekeeping was in 1946.6 Ladies’ Home Journal discussed the negative perceptions of menopause, but rather than promulgate such ideas, the article pushed women to frame it differently. “This change…is an episode that may touch women of any age and be source of much anxiety. Yet the change of life is not to be feared…menopause… is so generally misunderstood.”7 Some of the first representations of the “medicalization” of menopause can be seen in magazines during this time.

Pharmaceutical companies advertised and sold estrogen to women through popular media, since women often gathered their health information from magazines such as Newsweek, Harper’s Bazaar, Time, Good Housekeeping, Reader’s Digest, Ladies’ Home Journal, and Vogue. Popular news sources often portrayed HRT in a positive light. One article featured in Vogue titled, “How to Live Young at Any Age” described the benefits of HRT, including prevention of heart disease, even though there was no substantial evidence supporting this notion at the time.8 Physicians even wrote some of the pieces featured in such magazines. One physician-written article featured in The Ladies’ Home Journal asserted that:

Despite baseless fears, estrogen is usually safe and effective in relieving the distressing symptoms of menopause. It is perfectly natural for women to wish to slow up the aging process and to remain more attractive. They don’t hesitate to use contact lenses…color rinses…Then why should they put up with the discomforts that afflict about half of them in middle age, when the menopause begins?9

Such excerpts completely discounted any possible negative side effects, exemplifying the extent to which the media helped to create this notion that HRT was safe to use.

With the increase in advertisements, menopause went from a topic rarely discussed to one that was more mainstream. Magazines in the 1960s also began delineating menopause as a “disease.” Forms of hormone replacement therapy soon became promoted as a way of retaining one’s youth, maintaining attractiveness, and keeping spouses. Menopause was never portrayed as a natural part of a woman’s life, but rather as a period to dread and to be avoided with treatment. Hormones became the saving grace to stop aging.

Similar messages were taken up by publications everywhere for the next decade with features claiming, “There is a pill that appears to play a vital role in the prevention of aging in women…women can live happier and longer…the only people who stand to be affected by this revolution in hormone therapy may be: all the women on earth.”10 Good Housekeeping even tried drawing comparisons between cleaning a home and the maintenance of a woman’s body by means of hormone treatments: “Modern medical science has swept away the cobwebs of superstition, opened wide the windows of the mind to the light of facts, and developed proven therapeutic methods for treating symptoms.”11 Harper’s Bazaar published that “…prevalent medical opinion is that the safety and benefits of estrogen therapy have been convincingly demonstrated” even if there was no definitive consensus on the legitimacy of DES and other hormone therapies.12

Although most publications were jumping on this bandwagon, there were some articles calling out a need for concern. One writer in Better Homes and Gardens mentioned, “Some years ago, estrogen hormones were made available for use, when necessary, in women severely disturbed by menopause. Always, the idea of some simple panacea – some cure-all in pill or shot form – has a strange fascination. And estrogen got an immediate and eager acceptance. Too eager and too misinformed!”13 Reader’s Digest cautioned subscribers “no pill can make one young again. Nor can a pill make one feminine.”14 However, despite dissenters, the HRT fad continued through the decade, with no end in sight.

 

Conclusion

It was not until 1975 that HRT received substantial negative press among the more influential news sources such as the New York Times.15 The beginning of the downfall of HRT began with studies showing that the use of estrogen led to endometrial cancers.16 Although estrogen therapy had been linked to cancer as early as the 1930s, there was no substantive study that verified this common claim.17 In 1975, two articles featured in the New England Journal of Medicine called into the question the frequent dismissal of cancer by the popular press.18 Two research centers independently concluded that there was a link between endometrial cancer and postmenopausal estrogen therapy.19 This was not a story that remained in medical journals solely for the eyes of medical professionals. The mainstream media, such as the New York Times, swiftly took hold of these findings. However, one of the most definitive assertions of the negative effects of HRT came about in 2002 when the U.S. federal government prematurely ended a study by the Women’s Health Initiative.20 The study looked at the risks and benefits of hormone replacement therapy on disease prevention.21 Researchers found increased risks of blood clots, heart disease, breast cancer, and stroke.22

This 2002 finding shocked women across the country. It led many to question what had brought us to this point. How had this need to “treat” menopause come about? What persistent anxieties led women to almost blindly accept the trust of the media and its messages on HRT starting in the mid-twentieth century? HRT would not have lasted fifty years and generated such indelible appeal if the benefits of HRT were not promulgated by media throughout the past century.

 

References

  1.  Carla M. Obermeyer, “Menopause Across Cultures: A Review of the Evidence,” Menopause 7 (2000): 184-92.
  2. Judith A. Houck, Hot and Bothered: Women, Medicine, and Menopause in Modern America (Cambridge, Mass.: Harvard University Press, 2006), 2.
  3. Ibid., 46.
  4. Robert A. Wilson, Feminine Forever (New York: Evans, 1966), 10.
  5. “Premarin,” Obstetrics and Gynecology, May 1965, 5.
  6. James Scott, “You Need Not Fear the Menopause,” Ladies’ Home Journal, March 1946, 33.
  7. Ibid., 33.
  8. “How to Live Young at Any Age,” Vogue, August 1965, 61-64.
  9. Sherwin A. Kaufman, “The Truth About Female Hormones,” Ladies’ Home Journal, January 1965, 22.
  10. “How to Live Young at Any Age,” 61.
  11. Maxene Davis, “The Menopause,” Good Housekeeping, July 1943, 30.
  12. “Bazaar’s Over-40 Guide on Health, Looks, Sex,” Harper’s Bazaar, August 1973, 87.
  13. Lawrence Galton, “What Every Husband Should Know about a Woman’s Change of Life,” Better Homes and Gardens, July 1950, 127.
  14. Grace Naismith, “Common Sense and the Femininity Pill,” Reader’s Digest, September 1966, 99- 102.
  15. Houck, Hot and Bothered, 230.
  16. Ibid., 200.
  17. Ibid., 200.
  18. Harry K. Ziel and William D. Finkle, “Increased Risk of Endometrial Carcinoma among Users of Conjugated Estrogens,” New England Journal of Medicine 293 (1975): 1167-70, accessed November 12, 2015, doi: 10.1056/NEJM197512042932303;
  19. Donald C. Smith, et al., “Association of Exogenous Estrogen and Endometrial Carcinoma,” New England Journal of Medicine 293 (1975): 1164-67, accessed November 12, 2015, doi: 1056/NEJM197512042932302.
  20. Ibid., 1169.
  21. Writing Group for the Women’s Health Initiative Investigators, “Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women,” Journal of the American Medical Association 288 (2002): 321-333, accessed November 1, 2015, doi: 10.1001/jama.288.3.321.
  22. Ibid., 330.
  23. Ibid., 330.

 


 

PAVANE L. GORREPATI is a second-year medical student at the University of Iowa Carver College of Medicine. Born and raised in Iowa, she ventured out to the east coast for a few years, where she completed her undergraduate education at Yale University. She completed her undergraduate degree in the History of Medicine, Science, and Public Health.

 

Spring 2019  |  Hektorama  |  Doctors, Patients, and, Diseases