Click below for the fun part, replete with sexist ads from the 1960s. Make sure you read the ad text.
The Transition to Menopause
Menopause is defined as the cessation of ovarian function. It occurs at the average age of 50 in women, is accompanied by a decrease in circulating levels of estrogen and progesterone associated with the loss of follicular activity, and, following one full year of amenorrhea the start of menopause is retrospectively designated as after final menses. The transition to menopause, referred to as perimenopause, begins roughly two to eight years earlier and extends one full year past final menses. Cycles may become shorter and levels of follicle stimulating hormone rise to compensate for a decreased number of ovarian follicles. Middle perimenopause is characterized by a transitional period where cycles become shorter and intervals between them increase. Levels of ovarian hormones become erratic and other symptoms such as hot flashes and uterine bleeding may become increasingly common. During late perimenopause-- or the year following the last menstrual cycle-- ovulation no longer occurs and estradiol (E2), the principal circulating estrogen, is no longer produced by follicles. The ovary continues to manufacture testosterone and estrone (E1, which is now the primary circulating estrogen), and the primary source of E2 is the aromatization of testosterone and androstenedione. Progesterone continues to be produced in smaller amounts by the adrenals (Greendale and Sowers, 1997).
History of Postmenopausal Hormone Therapy: Historically, the menopause was generally framed as a positive event for women who, having endured the rigors and burdens of childbearing and menses, had now earned the right to focus on themselves:
After a certain number of years, woman lays aside those functions with which she has been endowed for the perpetuation of the species, and resumes once more that exclusively individual life which has been hers when a child… The evening of her days approaches, and if she has observed the precepts of wisdom, she may look forward to a long and placid period of rest, blessed with health, honored and loved with a purer flame than any which she inspired in the bloom of youth and beauty.
Premarin was five times as expensive as the competing product, which led to an ad campaign that marketed Premarin as an “upscale” therapy (Seaman, 2003). Initial advertisements for this drug, which would eventually become the most prescribed estrogen therapy, showed women in a highly glamorized light, surrounded by handsome men, happy families, and having fun. This campaign was successful, leading Ayerst to initiate an educational program for physicians on menopausal symptoms and therapies. Premarin use skyrocketed in the 1960s partly due to the highly successful “Keep her on Premarin” ad campaign that mixed authoritarianism with sexism, replacing the historical outlook of menopause as a natural transition with one of a deficient state to be treated for the rest of a woman’s life.
Ironically, Premarin was placed on the market one year after reports suggesting that estrogen may cause cervical cancer in animals (Seaman, 2003).
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Greendale GA, Sowers M. 1997. The Menopause Transition. Menopause and Hormone replacement Therapy 26:261-277.
Merck Manual Diagnosis &Therapy. New York: Merck and Co.; 1899.
Seaman B. The Greatest Experiment Ever Performed on Women: Exploding the Estrogen Myth. New York, NY: Hyperion; 2003.
Speert H. Obstetrics and Gynecology in America: A History. Chicago: The American College of Obstetricians and Gynecologists; 1980.
Speroff L. Clinical Gynecologic Endocrinology and Infertility. 6th edition. Baltimore, MD: Williams and Wilkins; 1999.