Massey University, Wellington, New Zealand.
Soc Sci Med. 2011 Oct;73(8):1238-45. doi: 10.1016/j.socscimed.2011.07.024. Epub 2011 Aug 26.
Menopause is understood, portrayed, and experienced in diverse ways. The dominant biomedical perspective medicalizes menopause as a biological 'hormone deficiency' requiring 'treatment' with hormone replacement therapy (HRT). Alternative perspectives view menopause as discursively located within particular socio-historical times and places, or privilege women's embodied experiences of menopause. We argue that the meanings of menopause and HRT should be debated within a context where the biological and the social, or the body and culture, intersect. The present study examined international medical student textbooks as sites of current biomedical knowledge, communicated for a new generation of health professionals. We undertook a Foucauldian discourse analysis on eight widely-used, international medical textbooks across physiology, pathology and pharmacology subject areas to identify the ways in which menopause and HRT are portrayed. Our results showed that menopause continues to be represented through dominant culturally infused 'failure' discourses and is portrayed as a 'precursor to disease' with HRT as the treatment. However, this knowledge is somewhat destabilized by a discourse of 'uncertainty and speculation' regarding the physiology of menopause and the potential effects of HRT. Knowledge about menopause, osteoporosis, and HRT was constructed as tentative, but the 'quest' for new knowledge was constructed as on the verge of 'exciting discoveries'. We argue that bio-social understandings of menopause and HRT, and their medical uncertainties, need to be addressed in medical curricula to ensure that doctors engage with midlife women in appropriate and positive ways, especially given the increased call for women's involvement in decision-making at this time.
绝经被以多种方式理解、描绘和体验。占主导地位的生物医学观点将绝经视为一种生物“激素缺乏”，需要用激素替代疗法（HRT）进行“治疗”。替代观点将绝经视为在特定的社会历史时期和地点的话语定位，或者重视女性绝经的身体体验。我们认为，应该在生物与社会、身体与文化交叉的背景下，对绝经和 HRT 的含义进行辩论。本研究以当前生物医学知识的传播场所——国际医学生教科书为研究对象，这些教科书是为新一代医疗保健专业人员编写的。我们对涵盖生理学、病理学和药理学领域的八本广泛使用的国际医学教科书进行了福柯式话语分析，以确定绝经和 HRT 的描述方式。研究结果表明，绝经继续通过主导的文化渗透“失败”话语来代表，被描绘为“疾病的前兆”，HRT 是治疗方法。然而，这种知识在一定程度上被绝经生理学和 HRT 潜在影响的“不确定性和推测”话语所破坏。关于绝经、骨质疏松症和 HRT 的知识被构建为不确定的，但对新知识的“探索”被构建为即将“令人兴奋的发现”。我们认为，需要在医学课程中解决绝经和 HRT 的生物社会理解及其医学不确定性问题，以确保医生以适当和积极的方式与中年女性接触，尤其是考虑到此时女性在决策中更多地参与的呼吁。
