Comment EDITOR’S COMMENTwith LOUISE FRAMPTON THE CLINICAL SERVICES JOURNAL Editor


Louise Frampton louiseframpton@stepcomms.com


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Overmedicalisation: a problematic term?


In the lead up to International Women’s Day, I read a press announcement that ‘experts warn about the overmedicalisation of menopause’. There are many valuable take-aways from this paper, published in The Lancet – such as there needs to be a societal shift in how menopause and midlife women in general are perceived; and that we need more supportive cultures. (https://www.thelancet.com/series/menopause-2024) The article promoted welcome discussion on a subject that has historically been ignored and taboo. So, why does the choice of headline on ‘the overmedicalisation of menopause’ makes me feel rather uneasy? Perhaps, it is because the term ‘overmedicalised’ begs the question: who exactly gets to decide what is ‘overmedicalised’? In relation to women’s health, there has been a long and problematic history of women being denied treatment and not being listened to for anything that is deemed ‘women’s problems’ – whether it is for the menopause, endometriosis, extreme bleeding, or pain relief. Certainly, my own experience of accessing anything resembling ‘medicalisation’ – or a solution – for issues relating to menopause, is that it can be a long and frustrating road, full of hurdles and of being dismissed. So, is the warning that menopause is ‘overmedicalised’ in step with the experiences of many women? HRT may be ‘medicalisation’, but it is life-changing for many women – enabling them to regain a quality of life that menopause took away. Rather than being ‘overmedicalised’, women are still having to fight for access to HRT – we have experienced shortages in supply and menopause forums are filled with stories of women who report having their symptoms dismissed and ignored. They say they are frustrated at being handed antidepressants, instead of hormone therapy; and some describe being told by their GP that they ‘don’t believe in prescribing it’. Women still experience the attitude that menopause is a natural part of ageing as a woman, therefore they should ‘put up and shut up’ - even when they are finding it hard to function with brain fog, memory problems, extreme mood swings, lack of sleep, urinary infections (the list goes on…) However, my concern over the term ‘overmedicalisation’ goes much further than just the menopause. A study titled ‘The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain’, found that women were less likely to receive aggressive treatment when diagnosed and were more likely to have their pain dismissed. Securing a diagnosis and accessing treatment for endometriosis and extreme pain around menstruation is still a problem for many women. On average, it takes 8 years and 10 months, from onset of symptoms, to get a diagnosis for endometriosis (Endometriosis UK). Often the underlying belief is that such pain is ‘just part of being a woman’ and that you ‘should live with it’. Sometimes, beliefs around ‘overmedicalisation’ can also become dangerous. When I gave


birth to my son, I was left to endure 60 hours of labour that failed to progress because of an ideology that we must avoid the ‘overmedicalisation’ of childbirth. It nearly didn’t end well for my son, and I’m grateful for the intervention of a passing consultant who insisted I should be whisked into the operating theatre. We have moved the dial from a time when consultants decided to induce labour to suit their requirements, to a time when the Morcombe Bay investigation highlighted the pursuit of “normal” births “at any cost”. This shift in the dial was prompted by well-meaning fears of ‘overmedicalisation’, but we need to exert some caution when applying such terms. The article in The Lancet raises some important issues for discussion and I do not wish to take away from that. But, too often, ‘overmedicalisation’ is a belief that limits women’s choices and access to care that would improve their quality of life. The difficulty is when this becomes ideology and used by the gatekeepers of medical intervention in a paternalistic way – it can feel like another hurdle for women to overcome.


louiseframpton@stepcomms.com Get in touch and give us your views, email me:


April 2024 I www.clinicalservicesjournal.com 5


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