title: The replacement of the replacement in menopause: hormone therapy, controversies, truth and risk.
abstract: A Foucauldian discourse analysis is employed to identify how our current understandings of menopause are culturally and historically determined by medical discourse. The polarity of the normal and the abnormal (pathological) became the crux of medical deliberation, where deviation from norms becomes the reason for intervention. Through manifold relations of power and the 'struggle of knowledges' medicine derives social authority, influencing social orthodoxies thus normalising menopausal women via discursive constructs. The course of nature in ageing women has been re-categorised as unnatural. In using the case of hormone therapy (HT) and the emergence of bio-identical or natural hormones, while deconstructing the premises used in marketing both types of hormone therapy, the tenuousness of scientific claims about these hormones is revealed. Discourses on bio-identical hormones (BHT) display a reliance on seemingly opposing naturalist and scientific arguments. Menopause, having been constructed as a deficiency disease, required initially chemical hormone replacement and now bio-identical hormones replacing the mainstream medical solution. The idea of the postmenopausal state as diseased is perpetuated as the basis to suggest therapies to women. This paper suggests that although therapeutic in a few cases, hormone preparations are in fact potentially dangerous lifestyle drugs.
authors.affiliation: University of Otago, Christchurch 8140, New Zealand. beverley.burrell@otago.ac.nz
authors.forename: Beverley A
authors.initials: BA
authors.lastname: Burrell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D014342:Truth Disclosure