When I was 25, I started drinking eight glasses of water a day.
Ever mindful of the latest health news, although much less experienced and discerning, I’d read several articles quoting doctors saying that was the amount that we needed for optimal hydration.
It was only after years in journalism that I began to question the origins of what has become my most healthy – and annoying – habit. It turns out that if you drink eight glasses of water a day, religiously, for years, eventually you must drink eight glasses of water a day always and forever, or you will feel very, very thirsty.
If I had the time and the funds, I’d trace that “8 glasses” messaging backwards from the editorial pages where I read it. I suspect it was connected to the introduction of plastic bottles. After all, it’s standard, old-school marketing for a new product, or even an old product in a new container: hire a pricey PR team, find a doctor to say that we needed lots of whatever it was being sold to be healthier. Issue a press release quoting the doctor talking about how much we needed about the new thing, or the new amount of the old thing. And then sit back and watch as that message is repeated, over and over and over, in legitimate editorial pages – without anyone really trying to get to the bottom of it or ever making the connection.
Nowadays I only need to open a newspaper or read an online health news article to spot the fingerprints of a PR firm all over it – and that includes the menopause space. Add in all the doctors and influencers on social media who are paid to spread messages, funding they may or may not be transparent about. (There is a lot of room for this in a modern-day “partnership”).
I see this sort of thing all the time. Things connected to sales of things just don’t generally appear out of nowhere. Follow the money, and all that.
And that’s why I’m so skeptical of the language around menopause hormone therapy, aka hormone replacement therapy (HRT). And it’s why I find the discussion about the frequent use of the term “estrogen deficiency” fascinating.
Dr. Jerilynn Prior is about as credible as you can get: an American professor of endocrinology at the University of British Columbia, and scientific director at the Centre for Menstrual Cycle and Ovulation Research.
And although we see the term “estrogen deficiency” everywhere these days, she’s also not buying it.
“It is a catchall term that plays into a cultural notion that estrogen is what makes a woman a woman,” writes Dr. Prior in a Scientific American essay. “I am now 77 years old and am 20 years into my own menopause. Yet, I robustly argue that I am not ‘estrogen deficient’. Why? Because my low estrogen and progesterone levels are normal for my age. And menopause is a normal life phase.”
She continues: “Does ‘estrogen deficiency’ even exist? Not alone, it doesn’t… So, why do we keep hearing about ‘estrogen deficiency’? Because it is a very effective marketing term. It was made by and for estrogen-selling companies. It implies that estrogen, and estrogen alone, is a necessary and effective treatment.”
Modern medicine is a beautiful thing, and even though we may not have been designed to suffer from low hormones at menopause, we certainly have evolved to; these days our environments, toxins, longer lives, autoimmune disorders, varying levels of trauma and socioeconomic factors, as well as individual genetics, lifestyles and risk factors for bigger problems, all play a part.
Adding to the confusion? Medical professionals who differ wildly in their “facts” yet offer them up with utmost certainly. No one can agree on many of the most basic things: for example, how much estrogen and progesterone we make after menopause in other parts of our body – tissues, adrenal glands, etc. I have three books on my coffee table by three different doctors, and they all say different things, from “undetectable” to a “healthy” amount.
Either way, it’s comforting when someone as experienced as Dr. Prior calls out this sort of ‘truthiness’ when she sees it.
Dr. Prior also highlights that the term hormone replacement therapy, or HRT, is incorrect – another excellent marketing tool – and that the proper term is menopause hormone therapy, or MHT, even though almost no one uses it. No wonder: one is steeped in lack and loss; the other is not. (I personally think we should call it H-TUT, for hormone topping-up therapy. Snappier acronym.)
Please understand that knowing ‘estrogen deficiency’ is a marketing term takes nothing away from how MHT, aka HRT, is being used to help people cope with the perimenopause and menopause transition. Just as the newish label “Low T” (also, I suspect, a marketing creation) is helping men get the testosterone treatment they need to cope with the increasing number and severity of symptoms that accompany their much more gradual andropause.
In the end, we are all being marketed to, right? I certainly don’t regret all the water I’ve consumed over the years; I’ve watched the evidence for being properly hydrated pile up for 25 full years now. I hope to do the same thing with hormone therapy and all the other therapies we are seeing emerge, including cannabis, psychedelics and more.
However, when it comes to something as important as my health, I will always want to know when a normal human experience is being twisted and tampered with by those who wish to influence my behavior for commercial gain.
Ann Marie McQueen is the founder of Hotflash inc, a global platform to inform, inspire and entertain people in peri/menopause while bridging the gap between mainstream medicine and holistic care.