A Peri Important Debate: Women's Health Advocates Anne Rochon Ford and Barbara Mains Debate the Pros and Cons of the Term 'Perimenopause.' What Are the Implications for Women's Health?
Mains, Barbara, Ford, Anne Rochon, Herizons
ANNE ROCHON FORD: It's everywhere! You'd think that perimenopause--the time around or near the time of menopause--was some kind of pandemic!
BARBARA MAINS: Do you think it's a ploy that's been developed to help expand the market of the pharmaceutical industry?
ROCHON FORD: Yes, but it's not only the pharmaceutical industry. The makers of vitamin supplements are bandying it around, too. The term existed, of course, long before marketing departments got hold of it. It's a medical term and that's part of the problem. I see it as another example of the way medical language can make a natural life transition seem like a disease.
MAINS: But is it more problematic than, say, the term 'prenatal'? Or any other medical term that's widely used? ROCHON FORD: I do think that 'perimenopause' is more problematic. The term makes you think that something very serious is going on and that you should consult with your doctor to take care of it. It feeds into the notion that women require treatment to 'cope' with menopause and that they should start preparing for it ahead of time. It's not enough to undergo so-called 'screening tests' at menopause. Now, we should really start a decade earlier!
I do think that overusing the term 'perimenopause' is a way of warming women up to the idea of taking drugs at menopause and having potentially dangerous, unnecessary mammograms and other diagnostic tests before they need them.
MAINS: A label may promote undue anxiety--but isn't the other side of the coin legitimate prevention? Forewarned, forearmed. If the label brings greater attention to the years directly preceding menopause, it may nudge women to start sifting through the information overload that is going to confound many of them at midlife--and to start prevention work that may pay off in later years.
ROCHON FORD: That is true in some respects. If more young women maintained a healthy body weight beginning in their teens, consumed less red meat, caffeine and carbonated drinks, and made exercise a regular part of their lives, they would be healthier in their 50's and 60's.
MAINS: But back to perimenopause. I agree that it has a suspicious sound in the mouth of 'big pharma.' Let me make a case for it, on the other hand, as I hear women using it--as an innocuous, convenient term. The limitation of the term 'menopause' is that it applies only when cycles have definitively ceased. But how are we to describe ourselves during the years just before they cease? Remember, the years in which women approach menopause vary widely--in the age at the onset of symptoms, in duration, and in the symptoms themselves. We need a short, flexible umbrella term to cover these wide-ranging experiences while they're still happening. 'Perimenopause' links itself logically to menopause, which is the next phase. It may be a medical term, but it's not a difficult one to decode. ROCHON FORD: Why label this time of life at all? It's interesting that in their book, So Many Changes: Women, Health and Midlife, Mary J. Breen and Lindsay Hall (Lawrence Heights CHC Press, 1999), the authors barely use the term perimenopause and yet manage to say quite a bit about it.
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Medical labels encourage medical solutions, which can be both costly and unnecessary. I draw a parallel to the very questionable efforts on the part of the pharmaceutical industry to turn female sexual problems into a disease for which there is a pill. The Working Group on a New View of Women's Sexual Problems (http://www.fsd-alert.org) have done a great job in drawing attention to the simplistic way the industry has turned female sexuality into something potentially pathological in an effort to compete in the race for "a female Viagra."
If women didn't use a label, but simply described their symptoms as they arose over this natural period of change, maybe they'd feel more in charge. The act of labelling encourages women to see aging as an accumulation of mounting risks that they can only fend off by taking drugs. …