The Change: Women, Ageing and the Menopause

The Change: Women, Ageing and the Menopause by Germaine Greer. Penguin Books, £9.99, pp 480. ISBN 0 14 012669 4. First published in 1991 by Hamish Hamilton. Rating: ★★★★

Germaine Greer is fated to be a prophet with few followers. From the knickerless groupie of the free love days, exhorting women to explore their own genitals, to the middle aged woman advocating joyful celibate cronehood, Greer's vision has always been idiosyncratic. Her interpretation of sexual liberation has evolved as she herself has aged, but she has not always succeeded in taking women with her.

In The Change: Women, Ageing and the Menopause she argued that women would come into their true selves when middle age disqualified them sexually. She urged women to use their invisibility to seize their own power and she warned them of the Evil Empire—gynaecologists and pharmaceutical companies, peddling the panacea of postmenopausal hormones.

It is now 11 years since Greer's book was first published. In that time hormone replacement therapy has been normalised as what women do at the menopause. In the United States, this started happening a long time ago. When I toured the USA, promoting my book The Menopause Industry: A Guide to Medicine's Discovery of the Mid-Life Woman (Penguin, New Zealand), published in the same month in 1991 as Greer's book first appeared, I found that women couldn't comprehend my own strategy to “do nothing.” I produced tennis as my personal menopause management strategy, thus rescuing myself from being totally written off.

At that time I naively thought that my own salt-of-the-earth New Zealand countrywomen would never come under oestrogen's thrall. But recent data show that between 1991 and 1997 the proportion of kiwi women who had ever used hormone replacement therapy increased from 19% to 32% and women currently using oestrogen at the time of the survey increased from 12% in 1991 to 20% in 1997. The reasons given for using HRT have broadened. More women are using HRT for prevention with a quarter of women using HRT for prevention of heart disease (New Zealand Medical Journal 2001;114:250-3). A survey by the New Zealand Guidelines Group in May 2001 showed that one third of current users started using HRT for “emotional stability,” while 17% said that looking younger and benefits to skin were other reasons for starting (www.nzgg.org.nz).

However, questions have been raised about short and long term risks to women of HRT and the lack of long term benefits. The cornerstone of long term use has been prevention of heart disease and osteoporosis, but recent research findings have severely challenged these claims. Preliminary results from the US National Institutes of Health Women's Health Initiative show more heart attacks, blood clots, and strokes in women using HRT (www.nhlbi.nih.gov/whi/index.html).

But these warnings are making not even a dent in the enthusiasm of women and their doctors for HRT. Postmenopausal hormones are the world's best selling prescription drugs. The New Zealand Guideline on the Appropriate Prescribing of HRT—which concluded that HRT was not recommended for use at the menopause and which is by far the most rigorous guideline in Australasia—barely earned a place on the platform at the 5th Australasian Congress on the Menopause held in Melbourne last October and was clearly seen as aberrant. Instead medical opinion leaders, unwavering in their devotion to oestrogen, regaled the audience with a smorgasbord of indications for using HRT.

In the 21st century, medicalisation has become mainstream, even desirable. Letting nature take its course is not an attractive argument when popular culture presents consumerist solutions to social problems and when the public is persuaded to regard medical intervention of even an extreme kind as a personal choice.

Seventeen year olds take out bank loans to pay for silicone breast implants while their mothers and even grandmothers have animal toxins injected into their wrinkles. The skin is mapped according to its potential for malignancy. Orifices are scrutinised for suspicious lumps and bumps. Foods are pumped full of extra substances. Even wine is now eulogised for its medicinal properties.

Today's “worried well” don't know any other state.

Women like Greer and I emerged from the '60s sexual revolution and went about consciousness raising to learn to love our body hair, female smells, and bodily imperfections. With the demise of the feminist movement, there is no one to contest the reassertion of traditional ideals of femininity. Today's cultural acceptance of HRT depends on a stereotype of women as eternally youth seeking and narcissistic, everything we railed against. In Greer's words, women of our own time are “allowed to be nothing but body.”

The triumph of HRT has been achieved at the same time as women in many countries are reaching the highest echelons. In my own country, the prime minister, attorney general, chief justice, and governor general are all mid-life women. The tragedy of HRT is that so many women risk so much to gain so little.

Figure.

STEFAN ROUSSEAU/PA

Germaine Greer: warned women to beware of gynaecologists and pharmaceutical companies