Unravelling the account of menopause as hormone deficiency: working practices of the menopause clinic

© 1996 Dr. Marilys Noelle GuilleminThe menopause arena is highly political and is riddled with controversies and complexities. Debates rage about the medicalisation of an otherwise normal life event and the use of HRT, particularly the association of HRT with increased risks of cancer, as well as its use in the long term prevention of osteoporosis and heart disease. Feminists have made significant and worthwhile contributions towards addressing these and related issues, as well as opening up these debates to public scrutiny. Within this controversial forum, one particular understanding of menopause has gained prominence, namely the notion of menopause as a disease of deficient hormones. The focus of this thesis is on how this particular concept of menopause has come to be stabilised as ‘fact’. I argue that this understanding of menopause as hormone deficiency is a socio-material construction, and as such, is only one of many possible constructions of menopause. Given these possibilities, how then has this particular understanding come to be so prevalent, not just in medical practice but in everyday life? To examine this question, I employ a feminist interactionist science studies approach which focuses on how knowledge is generated through the standardisation of social-material practices. This approach combines (i) science studies, in particular actor network theory, (ii) symbolic interactionism, emphasising interactionist studies which bridge the gap between science studies and symbolic interactionism, and (iii) feminist critiques of medicine, science and technology. I situate my exploration in menopause clinics - specialised, largely medical sites where women's menopausal problems are managed and treated. The menopause clinic brings together many disparate collectives, including gynaecologists, endocrinologists, physicians and psychologists each providing different forms of specialised management, as well as material technologies such as bone densitometry, HRT, mammography and ultrasound. My focus is on the every day practices of the menopause clinic which both maintain the very existence of the clinics and are vital to the production of knowledge about menopause. Several key practices of the clinic are examined to show how the particular understanding of menopause as hormone deficiency is constructed and generated through the working of these practices. Focussing on these social-material practices and interactions reveals how this particular understanding of menopause is shaped and stabilised. In tracing the stabilisation of the menopause clinic and its concomitant understanding of menopause as hormone deficiency, I argue that despite its seemingly stable facade, the menopause arena is fraught with ambiguities and contradictions. Positioning my focus at the level of practices reveals that many of the clinic’s practices are simultaneously complicit and resisting. I follow these interruptions to the clinic’s network of relations and trace how they offer potential disruptions to the current orderings of the clinic and the prevalent understanding of menopause as hormone deficiency. Directing attention to how particular knowledge claims come about makes visible other possible outcomes, thus opening up potential reconstructions of current knowledge claims about menopause