Student Blog Issue #5: This issue highlights the research of Keir Hesse.
Menopause has arguably never occupied as much public attention as it does today. News articles and documentaries, changing workplace regulations, and a renewed interest in hormone replacement therapy (HRT) have coincided with a massive uptick in the demand for menopause-related healthcare. And though both National Health Service (NHS) and private sector services have expanded rapidly, the landscape of access to good-quality formal care remains complicated. At the same time, managing the symptoms of menopause often begins not in clinics, but elsewhere: in supermarket health aisles; after clicking on an advert promoting a new supplement regime; tracking sleep or mood in notes app entries; or by seeking out information from discussions in online forums and conversations with friends who have already ‘been through it’. Before, alongside, or instead of going to the doctor’s, many people are managing their menopause symptoms on their own. Such informal arrangements and networks of menopause care have been the focus of my thesis fieldwork this year.
Receiving medical attention for menopause symptoms is conditioned by murky and contested medical discourses surrounding the ‘facts’ and ‘myths’ of menopause; reluctant or misinformed primary care practitioners who hold power over prescribing (1); and sometimes, medicine shortages (2). Systemic inequalities in HRT prescribing in the UK have been observed in a recent population study, which indicated that women of colour and those living in deprived areas had significantly lower prescription rates compared to white women living in affluent areas (3). The material factors impacting access to formal menopause care include the extent of local NHS waiting times, whether one has the ability to pay to see a private specialist, and how closely the presentation of one’s symptoms conforms to clinical expectations of menopause. One way of understanding the phenomenon of self-management is therefore to see it as a signal of unmet need, as people seek to fill the gaps left by formalised healthcare systems.
At the same time, possibilities for self-management have multiplied. The booming international pharmaceutical markets for HRT and the prevalence of medical tourism have opened informal routes for sourcing medications on top of prescription sharing. Meanwhile, increasingly online methods of sharing and consuming health-related information, products, and support have destabilised the traditional doctor-patient relationship, and social media, chatrooms, blogs, and podcasts have become ubiquitous resources for obtaining menopause-related information and care. These digital technologies that offer new ways to track symptoms, learn about menopause, and share experiential knowledge stand alongside enduring in-person networks of care, such as meeting with friends or attending menopause-specific peer-support groups. Seeing self-management as a routine and relational part of healthcare shifts the focus away from idealised models of patient behaviour, instead recognising that this is the reality of medical care for many. Menopause is not exceptional for this, but rather constitutes a particularly revealing case study.
Large online forums, held on platforms like Facebook and Reddit, function as encyclopaedias of anecdotal accounts providing evidence for or against almost any avenue of care – whether involving HRT, non-hormonal medical interventions, or lifestyle changes. The gargantuan challenge for many users then becomes figuring out how best to navigate these swathes of experiential information (that can often be contradictory). Whilst these larger forums may be experienced as impersonal and overwhelming, they can also provide emotional forms of support: anonymous posters ‘venting’ about challenges with their
partners, overwhelming or embarrassing symptoms, or negative experiences at the doctor’s surgery are met with reassurance, recognition, and shared understanding alongside practical advice from commenters.
My research hopes to arrive at a more expansive understanding of the decision to seek out alternative care infrastructures, rather than only seeing them as something which makes up for what formal healthcare lacks. Seen anthropologically, self-managed menopause care emerges as a site of innovation under constraint, where knowledge is collectively produced and developed through the embodied experience of being menopausal. Just as there are factors which might push people away from engagement with formal healthcare, I also hope to attend to what pulls them towards alternative infrastructures of care.
Throughout the Health, Medicine and Society MPhil, I have been able to nurture my interest in the social salience of hormones, pharmaceuticalisation, and changing biomedical notions of health and ‘normality’. My disciplinary background and enduring focus lies in anthropology and this has informed my research with people who use menopause support groups. I have also enjoyed the opportunity to work across the disciplines of medical anthropology, medical
sociology, and the history of medicine while staying with the same broad concerns. In a sociological essay on medicalisation and risk-centred medicine, for example, I considered the development and roll-out of PrEP (a medication used to prevent the spread of HIV) as a case study in which risk itself becomes manageable through pharmaceuticals. My inquiry centred on the relationship between the increasing onus to take personal responsibility for one’s health through pharmaceutical innovation and novel methods of diagnosing risk, and the ways this can affect our bodies, identities and relationships to others. I am currently in the process of researching for my third and final essay of the year, in history of medicine, on the role of late 20th century feminist literature for the creation and shaping of public perceptions of HRT for menopause in the UK. As I look towards taking my research on hormonal bodies to a doctoral level, I am excited to continue embracing interdisciplinary coalitions and ways of thinking.
Bibliography
1. Barriers to Accessing Effective Treatment and Support for Menopausal Symptoms: A Qualitative Study Capturing the Behaviours, Beliefs and Experiences of Key Stakeholders. Barber, K and Charles, A. s.l. : Patient Prefer Adherence, 2023, Vol. 17, pp. 2971-2980.
2. Why are there shortages of HRT and other drugs in the UK? Wise, J. s.l. : BMJ, 2022, pp. 1-3.
3. Inequalities in hormone replacement therapy prescribing in UK primary care: population based cohort study. Hirst, J, et al. 1, s.l. : BMJ Medicine, Vol.4.