Rationale At the request of a Dutch governmental organization, a multidisciplinary group of osteoporosis experts in the Netherlands published in 2002 a guideline on case finding, diagnosis, prevention and treatment of osteoporosis. These guidelines were evaluated for their validity and applicability. Methods Analysis by 5 external osteoporosis experts using the 'Appraisal of Guidelines for Research & Evaluation' ('AGREE') instrument. Results The score for the 6 domains of AGREE was 88% for the scope and purpose domain, 76% for (...) stakeholder involvement, 81% for rigour of development, 84% for clarity and presentation, 77% for applicability and 73% for editorial independence. For single components of the domains of AGREE, highest scores were found for systematic methods used to search for evidence (100%), inclusion of individuals from all the relevant professional groups (95%) and ease of identifying key recommendations (95%). Lowest scores to single components of the several domains were given for piloting among target users (44%). All experts recommended the guidelines for use in practice. Conclusions The AGREE instrument scored high for development, clarity and presentation but low for piloting among target users and implementation. Based on the guideline, algorithms from case finding to treatment were constructed that could be tested for piloting among target users and for implementation of the guideline. (shrink)

Osteoporosis (OP) is a bone disease which affects a number of post‐menopausal females and puts many at risk for fractures. A large number of patients are taking bisphosphonates (BPs) to treat their OP and a rare complication is the development of atypical femoral fractures (AFF). No real explanations for the mechanisms underlying the basis for development of where AFF develop while on BPs has emerged. The present hypothesis will discuss the possibility that part of the risk for (...) an AFF is a secondary effect of BPs on a subset of vascular cells in a genetically at‐risk population, leading to localized deregulation of the endothelial cell (EC)‐bone cell‐matrix units in nutrient channels/canals of the femur and increased risk for AFF. This concept of targeting ECs is consistent with location of AFF in the femur, the bilateral risk for occurrence of AFF, and the requirement for long term exposure to the drugs. (shrink)

Bisphosphonates are a class of drugs which have shown good efficacy in the treatment of post‐menopausal osteoporosis, as well as a good safety profile. However, side‐effects such as risk for atypical femoral fractures (AFF) have appeared, leading to a decline in use of the drugs by many patients who would benefit from the treatment. While patient characteristics have contributed to improved understanding of risk factors, the mechanisms involved that explain AFF risk have not appeared. Recently, the possibility (...) that the mechanism(s) involved drug‐induced modification of cells of the nutrient canals of the femur and subsequent compromise in the bone matrix has been published. The present Hypothesis article builds on the concept presented earlier and expands into biomechanical considerations. An analogy of the mechanisms involved to a real‐life scenario is also presented. While this analogy has limitations, consideration of the biomechanical implications of progressive alterations to defects presented by compromised nutrient canal‐bone matrix also presents potential relationships with AFF risk. (shrink)

Nonfeminist accounts of post-menopausal IVF reject the practice on four main grounds: I) scarcity of resources; 2) fairness; 3) the “inappropriateness” of post-menopausal motherhood; and 4) concerns for orphaned children. I argue that these grounds are insufficient for denying post-menopausal women IVF access. I then suggest that a feminist evaluation of the practice is more compelling; ultimately, however, we have no strong grounds for a policy denying post-menopausal women access to this technology.

“I am still in despair over losing my identity,” said a blog comment in a discussion about post-menopause weight gain. Instead of recovering an identity, for some of us, as women age, our attitudes toward fitness may require forging new identities. But the challenge in coming to desire fitness, post-menopause, is a project of actually changing my desires. Habituating a good practice can lead to a change in our appetites, so that instead of losing our identities, we may (...) become the characters that we set goals to be. (shrink)

Osteoporosis is characterized by reduced bone density and strength. Bone mass peaks between age 30 and 40 and then declines. This can be accelerated by factors including menopause and insufficient dietary calcium. Hormone replacement therapy (HRT) is currently the standard treatment for osteoporosis. However, growing concern over potential side effects of HRT has driven a search for alternative therapies. A recent report1 reveals a potential alternative to HRT: a gender‐neutral synthetic steroid that increases bone mass and strength without (...) affecting reproductive organs. This compound acts via a novel extranuclear sex steroid receptor signaling mechanism that has important implications for nuclear receptor biology and human health. BioEssays 25:195–199, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

Artificial gametes, derived from stem cells, have the potential to enable in vitro fertilization of embryos. Currently, artificial gametes are only being generated in laboratory animals; however, considerable efforts are underway to develop artificial gametes using human cell sources. These artificial gametes are being proposed as a means to address infertility through assisted reproductive technologies. Nonetheless, the availability of artificial gametes obtained from adult organisms can potentially expand the possibilities of reproduction. Various groups, such as same-sex couples, post-menopausal (...) women, and deceased donors, could potentially utilize artificial gametes to conceive genetically related offspring. The advent of artificial gametes raises significant bioethical questions. Should all these reproductive scenarios be accepted? How can we delineate the range of future reproductive choices? A normative bioethical framework may be necessary to establish a consensus regarding the use of human artificial gametes. This review aims to present the current state of research on the biological roadmap for generating artificial gametes, while also summarizing proposed approaches to establish a normative framework that delineates ethically acceptable paths for reproduction. (shrink)

The use of aggregated quality of life estimatesin the formation of public policy and practiceguidelines raises concerns about the moralrelevance of variability in values inpreferences for health care. This variabilitymay reflect unique and deeply held beliefs thatmay be lost when averaged with the preferencesof other individuals. Feminist moral theorieswhich argue for attention to context andparticularity underline the importance ofascertaining the extent to which differences inpreferences for health states revealinformation which is morally relevant toclinicians and policymakers. To facilitatethese considerations, we present (...) an empiricalstudy of preferences for the timing andoccurrence of health states associated withhormone replacement therapy (HRT). Sixteenwomen between the ages of 45 and 55 wereenrolled in this pilot study. Theirpreferences regarding five health statesassociated with HRT (menopausal symptoms, sideeffects of HRT, breast cancer, myocardialinfarction, and osteoporosis) were assessed inquantitative terms known as utilities. Twostandard methods, the visual analog scale (VAS) and the standard gamble (SG), were used toassess utility and time preference (calculatedas a discount rate). The wide variability ofresponses underlines the importance oftailoring health care to individual women'spreferences. Policy guidelines whichincorporate utility analysis must recognize thenormative limitations of aggregatedpreferences, and the moral relevance ofindividual conceptions of health. (shrink)

This paper, using modern Darwinian theory, proposes an explanation for the increasingly high incidence of breast cancer found among pre-and post-menopausal women living today in westernized countries. A number of factors have been said to be responsible: genetic inheritance (BRCA-1), diet (specifically the increased consumption of dietary fat), exposure to carcinogenic agents, lifetime menstrual activity, and reproductive factors. The primary aim of this paper is to demonstrate the value of a perspective based on Darwinian theory. In this paper, (...) Darwinian theory is used to explore the possibility that the increased incidence of breast cancer is due primarily to the failure to complete in a timely manner the reproductive developmental cycle, beginning at menarche and continuing through a series of pregnancies and lactation. On the basis of comparative data, we assume that most women in ancestral populations began having children before age 20 or so and tended to remain either pregnant or nursing for most of their adult lives. If a woman did not have a child by age 25 or so, she probably would never have one. Therefore, selection would probably not have acted against deleterious traits, such as cancer, that appeared after that age, just as it does not act against such traits in old age. (shrink)

The Future of Human Reproduction brings together new work, by an international group of contributors from various fields and perspectives, on ethical, social, and legal issues raised by recent advances in reproductive technology. These advances have put us in a position to choose what kindsof children and parents there should be; the aim of the essays is to illuminate how we should deal with these possibilities for choice. Topics discussed include gender and race selection, genetic engineering, fertility treatment, ovarian tissue (...) transfer, and post-menopausal pregnancy. The centralfocus of the volume is the interface between reproductive choice and public regulation. (shrink)

ABSTRACT The paper explores the ethics of post‐menopausal motherhood by looking at the case of Adriana Iliescu, the oldest woman ever to have given birth (so far 1). To this end, I will approach the three most common objections brought against the mother and/or against the team of healthcare professionals who made it happen: the age of the mother, the fact that she is single, the appropriateness of her motivation and of that of the medical team.

ObjectiveOverweight and obesity [body mass index ≥ 25 kg/m2] are associated with poorer prognosis among women with breast cancer, and weight gain is common during treatment. Symptoms of depression and anxiety are also highly prevalent in women with breast cancer and may be exacerbated by post-diagnosis weight gain. Altered brain function may underlie psychological distress. Thus, this secondary analysis examined the relationship between BMI, psychological health, and resting state functional connectivity among women with breast cancer.MethodsThe sample included 34 (...) class='Hi'>post-menopausal women newly diagnosed with Stage 0-IIa breast cancer who were enrolled in a 6-month randomized controlled trial of aerobic exercise vs. usual care. At baseline prior to randomization, whole-brain analyses were conducted to evaluate the relationship between BMI and seed-to-voxel rsFC of the hippocampus and amygdala. Connectivity values from significant clusters were then extracted and examined as predictors of self-reported depression and anxiety.ResultsMean BMI was in the obese range. For both seeds examined, higher BMI was associated with lower rsFC with regions of prefrontal cortex, including ventrolateral PFC, dorsolateral PFC, and superior frontal gyrus. Hippocampal connectivity with the vlPFC was negatively correlated with self-reported anxiety.ConclusionHigher BMI was associated with lower hippocampal and amygdala connectivity to regions of PFC implicated in cognitive control and emotion regulation. BMI-related differences in hippocampal and amygdala connectivity following a recent breast cancer diagnosis may relate to future worsening of psychological functioning during treatment and remission. Additional longitudinal research exploring this hypothesis is warranted. (shrink)

Our innate capacity for voice is with us from the beginnings of life. The concept of voice is a complex issue rooted in the core of the self. Once we become aware of ourselves, we realize our capacity for self-expression. Self-expression is part of the cooperative network of communication between the self and others as we share emotions, thoughts, and ideas. Voice facilitates a connection between the world of one individual and the world of another. The purpose of this article (...) was to explore and discover the processes, influences, attitudes and beliefs that affect a woman's ability to define her menopausal voice. A woman's voice expresses her knowledge, set of assumptions, concepts, values, and practices in the form of language. Voice becomes a manifestation of the essence of self, and when listened to, breaks the silence of non-existence. A menopausal woman's voice is the voice that expresses the entirety of her existence at that particular stage in life. Post-menopausal women were asked to define their menopausal voices. They were interviewed in depth and their information was collected through semi-structured interviews. This approach used a qualitative methodology with a focus on meaning of their voices rather than measurement. The format was narrative research using life stories and thematic analysis. As a result, five themes: The Voice of Wisdom, The Voice of Aging, The Voice of relationship, The Voice of Spirit, and the Voice of Knowledge emerged after analyzing the women's stories. Each theme represents the complexities that influenced the participants? competence to ascribe meaning to their voices. This article identifies the meanings that menopausal women associated with the concept of voice and how it changed during menopause. (shrink)

Alex Pruss argues that romantic love is a basic form of human love that is properly fulfilled in sex oriented towards reproduction. As a result, homoerotic sexual activity cannot obtain the proper consummation and therefore involves misunderstanding the other person’s nature and the possibility of union with them. Although same-sex sexual activity may feel like a consummation of romantic love, it is wrong to generate such a false experience in oneself or another. Presented is an apparent dilemma for Pruss’s thesis (...) suggesting that either both postmenopausal homosexuals and postmenopausal heterosexuals ought to be allowed to marry for their romantic love is not dysfunctional despite not being oriented towards reproduction, or that matrimony is inappropriate for both groups. I suggest avoiding the dilemma in either of two ways that would allow Pruss to distinguish the infertility of homosexual couples from the infertility of post-menopausal women. (shrink)

Judith Butler claims to have based her theory of gender performance on Simone de Beauvoir’s path-breaking idea that one is not born, but rather becomes, a woman. However, Butler’s interpretation of Beauvoir’s work departs considerably from Beauvoir’s own expressed view which is that women are shaped by an interplay of femininity (construed by cultural and structural norms) and sexed bodies and that the concept of woman is a mutable one that can accommodate increasing degrees of freedom. In this paper I (...) explore Beauvoir’s theories further, showing how they depart from Butler’s interpretations of them and in the process exploring the contribution that Beauvoir and Butler respectively make towards understanding ongoing gender inequality. Finally, I compare and contrast the role of temporality and the life course in ‘becoming a woman’ and in performing gender respectively, focusing on the figure of the post-menopausal woman in particular. (shrink)

Endometriosis, a chronic inflammatory condition affecting 10% of biological women, is widely understudied and particularly overlooked in later life. Discussions surrounding endometriosis predominantly centre on medical gender bias during reproductive years, with limited attention to intersecting factors of discrimination and the impact of ageism on affected individuals. As endometriosis is framed as a disease of reproductive age, research is lacking when it comes to the effects of the illness on the older population. Symptoms in (post)menopausal individuals are frequently (...) misattributed to other ailments due to ageist and sexist preconceptions, leading to prolonged diagnoses and mistreatment. This is a social justice issue in which age and sex contribute to the discrimination of a certain population – namely older biological women living with endometriosis. In this paper, we approach this issue from the perspective of epistemic justice. The experiences of the affected persons are shaped by a lack of knowledge about endometriosis among both the healthcare personal and the affected person, as well as a lack of acknowledgement and consideration of the persons experiences. Using the lens of epistemic justice, we develop an analytical model to understand the intersection of age and gender in the experiences of endometriosis patients. This article contributes to ongoing debates on epistemic injustice and intersectionality within medicine and healthcare, offering an analytical model that connects the critical approaches of epistemic injustice and intersectionality to address health injustice. Ultimately, this work advocates for a comprehensive, lifespan approach to endometriosis that acknowledges and addresses intersecting forms of discrimination. (shrink)

Catalysed by conversations amongst a group of colleagues, this article is an initial exploration of what happens to women academics aged 60+ who work in a university in Aotearoa New Zealand. This work is an example of when academic theories, in this case feminism, are called forth by real-world experiences – in this case, increasing academic job insecurity, catalysed by post-pandemic economic shortfalls. We blend together personal anecdotes and feminist analysis to show how women’s academic careers, which are commonly (...) constrained by motherhood in their younger years, are also curtailed at the senior end by processes of voluntary/involuntary retirement, as and when demanded by adverse fiscal conditions. (shrink)

Many clinicians are experiencing consumer resistance to the prescription of equine HRT (that is hormone replacement therapy which has been manufactured from mare's urine). In this paper I consider the ethical implications of prescribing these preparations. I decide that patients should have a right to refuse such treatment but also ask whether a prescribing doctor should choose one preparation over another on moral grounds. I determine that there is prima facie evidence to suggest that mares may suffer and that prescription (...) of equine HRT (instead of synthetic oestrogen-oestriol) would therefore have to be justified in terms of either offering greater benefits to the women or offering greater value for money to the health service. I find that there is no substantial evidence to suggest that equine HRT offers unique advantages over and above oestriol. I conclude that it would be preferable for a doctor to recommend the synthetic oestrogen to women who want relief from the symptoms of the menopause and protection from osteoporosis and cardiovascular disease. (shrink)

Menopause is an evolutionary mystery: how could living longer with no capacity to reproduce possibly be advantageous? Several explanations have been offered for why female humans, unlike our closest primate relatives, have such an extensive post-reproductive lifespan. Proponents of the so-called “grandmother hypothesis” suggest that older women are able to increase their fitness by helping to care for their grandchildren as allomothers. This paper first distinguishes the grandmother hypothesis from several other hypotheses that attempt to explain menopause, and then (...) develops a formal model by which these hypotheses can be compared and tested by empirical researchers. The model is then modified and used to respond to a common objection to the grandmother hypothesis: that human fathers, rather than grandmothers, are better suited to be allomothers due to their physical strength and a high incentive to invest in their own children. However, fathers—unlike maternal grandmothers—can never be sure that the children they are caring for are their own. Incorporating paternity uncertainty into the model demonstrates the conditions under which the grandmother hypothesis is more plausible than a hypothesis that focuses on the contributions of men. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Empire Writes Back, With A VengeanceDenis DuttonOne of the more uplifting aspects of the turn toward theory in recent years has been the growth of postcolonial cultural studies. Postcolonial studies are in actuality constituted by counterdiscoursive, decolonizing practices which acknowledge the recognition of minority discourses, deconstructing hegemonic texts and imperialist metanarratives, opposing unduly overprivileging Western canonical paradigms of “literature,” and—well, you know what I mean. As Benita Parry (...) so lucidly explains, “The labor of producing a counter-discourse displacing imperialism’s dominative system of knowledge rests with those engaged in developing a critique from outside its cultural hegemony.” And what an awesome labor it is. The noted postcolonial theorist Georg M. Gugelberger sums things up by saying (I’m not inventing this) “postcolonialism can be conceptualized as the last bulwark against an encroaching total capitalism.”But what of the struggling masses of oppressed peoples whose interests and cultural sensitivities are so caringly looked after by practitioners of postcolonial studies? How do they feel about the fact that the only thing standing between them and “total capitalism” is resistance being mounted in a comparative literature department in Idaho, or someplace? This is a question seldom asked, let alone answered. Fortunately, new light has been thrown on the matter with the arrival of a booklet at this journal. Indian History from Above and Below, by Rukun Advani, is published by Ram Advani, probably a member of the family, in Lucknow. It is dedicated to “all Bengali intellectuals and those whose dollar salaries rise in proportion with obscurity and jargon.” Advani notes in his preface that although Bengali intellectuals talk torrents in their native tongue, when they [End Page 198] disseminate their thoughts abroad, they translate into a “clogged, colonial, unfluid flow,” with footnotes such as: “Derrida; ibid.; see my recent essay on the modes and moods of Foucault in JPS, III.iii, 3–333; on Lacan, see Lacan, On Lacan; Barthes, how many times a day do you have one in summer; idem., do you really?; differentiated peasantry; undifferentiated peasantry; for a feminist, though partially anthropologized, hermeneutic-critical discourse on the post-colonial subversive dimensions of the undifferentiated middle peasant in Midnapore district in June 1959, see the provocative controversy between Ranajit da and Amiya da in Gayatri di, ed., Gendered, Gendered, O Most Gendered: Epistemology and the Male Menopause in Bengal between June 1959 and July 1959 (Oxford University Press, forty years later).”The first of the booklet’s two essays, “Indian History from Below: a Swiftian Consideration,” discusses a neglected but “important arena of subaltern existence, namely the history of belching, wind-breaking and defecation.” Just to name these three functions posits “a bourgeois hierarchy of disgust with what Marx, in one of his most decisively Derridesque reflections, termed ‘The Asiatic Commode of Production.’” Beginning with the Foucauldian notion of “the peasant’s overdetermined relative autonomy from the olfactory,” Advani describes “the Barthesian notion of the impossibility of critical transcendence by the historian into either the symbiotic acculturation of the pastness, and indeed the presentness, of the present-subject, or indeed the even greater epistemological and hermeneutic problems posed by attempting a recreation of the ontological presuppositions of the peasant.” Much of this is elaborated in the classic essay by Professor Lavatri Lavatory Spewhack, “The Post-Colonial Lavatory and Its Radical Implications for Nomenclaturing Among Gendered and Subalternized Third World Expatriate-Marxist-Feminists in the First and Second Worlds: A Derivative Discourse Decoded.”The debt that Rukun Advani owes to Professor Spewhack is clear from the sheer number of his references to books and articles by her. These include, on the subject of toileting, Master Disgusted, Native Disgusting: a Perspective on Peasants from 250,000 Dollars per Annum, “On the Symbolic Hegemony of Subsection Numbers in a Gendered and Subalternized Post-Colonial Context: A Derivative Discourse Decoded” (in The Phenomenology of Praxis and the Praxis of Phenomenology in a Postmodern Residential Colony), “The Violence of Steam and the Episteme of Violence: Foucault’s Views on Hot Air Balloons” (in Obscurata), and even parts of her autobiography: The Larger than Life of Lavatri Lavatory [End Page 199] Spewhack (chapter titled “My Collected Phonecalls and Faxes”). While some... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Empire Writes Back, With A VengeanceDenis DuttonOne of the more uplifting aspects of the turn toward theory in recent years has been the growth of postcolonial cultural studies. Postcolonial studies are in actuality constituted by counterdiscoursive, decolonizing practices which acknowledge the recognition of minority discourses, deconstructing hegemonic texts and imperialist metanarratives, opposing unduly overprivileging Western canonical paradigms of “literature,” and—well, you know what I mean. As Benita Parry (...) so lucidly explains, “The labor of producing a counter-discourse displacing imperialism’s dominative system of knowledge rests with those engaged in developing a critique from outside its cultural hegemony.” And what an awesome labor it is. The noted postcolonial theorist Georg M. Gugelberger sums things up by saying (I’m not inventing this) “postcolonialism can be conceptualized as the last bulwark against an encroaching total capitalism.”But what of the struggling masses of oppressed peoples whose interests and cultural sensitivities are so caringly looked after by practitioners of postcolonial studies? How do they feel about the fact that the only thing standing between them and “total capitalism” is resistance being mounted in a comparative literature department in Idaho, or someplace? This is a question seldom asked, let alone answered. Fortunately, new light has been thrown on the matter with the arrival of a booklet at this journal. Indian History from Above and Below, by Rukun Advani, is published by Ram Advani, probably a member of the family, in Lucknow. It is dedicated to “all Bengali intellectuals and those whose dollar salaries rise in proportion with obscurity and jargon.” Advani notes in his preface that although Bengali intellectuals talk torrents in their native tongue, when they [End Page 198] disseminate their thoughts abroad, they translate into a “clogged, colonial, unfluid flow,” with footnotes such as: “Derrida; ibid.; see my recent essay on the modes and moods of Foucault in JPS, III.iii, 3–333; on Lacan, see Lacan, On Lacan; Barthes, how many times a day do you have one in summer; idem., do you really?; differentiated peasantry; undifferentiated peasantry; for a feminist, though partially anthropologized, hermeneutic-critical discourse on the post-colonial subversive dimensions of the undifferentiated middle peasant in Midnapore district in June 1959, see the provocative controversy between Ranajit da and Amiya da in Gayatri di, ed., Gendered, Gendered, O Most Gendered: Epistemology and the Male Menopause in Bengal between June 1959 and July 1959 (Oxford University Press, forty years later).”The first of the booklet’s two essays, “Indian History from Below: a Swiftian Consideration,” discusses a neglected but “important arena of subaltern existence, namely the history of belching, wind-breaking and defecation.” Just to name these three functions posits “a bourgeois hierarchy of disgust with what Marx, in one of his most decisively Derridesque reflections, termed ‘The Asiatic Commode of Production.’” Beginning with the Foucauldian notion of “the peasant’s overdetermined relative autonomy from the olfactory,” Advani describes “the Barthesian notion of the impossibility of critical transcendence by the historian into either the symbiotic acculturation of the pastness, and indeed the presentness, of the present-subject, or indeed the even greater epistemological and hermeneutic problems posed by attempting a recreation of the ontological presuppositions of the peasant.” Much of this is elaborated in the classic essay by Professor Lavatri Lavatory Spewhack, “The Post-Colonial Lavatory and Its Radical Implications for Nomenclaturing Among Gendered and Subalternized Third World Expatriate-Marxist-Feminists in the First and Second Worlds: A Derivative Discourse Decoded.”The debt that Rukun Advani owes to Professor Spewhack is clear from the sheer number of his references to books and articles by her. These include, on the subject of toileting, Master Disgusted, Native Disgusting: a Perspective on Peasants from 250,000 Dollars per Annum, “On the Symbolic Hegemony of Subsection Numbers in a Gendered and Subalternized Post-Colonial Context: A Derivative Discourse Decoded” (in The Phenomenology of Praxis and the Praxis of Phenomenology in a Postmodern Residential Colony), “The Violence of Steam and the Episteme of Violence: Foucault’s Views on Hot Air Balloons” (in Obscurata), and even parts of her autobiography: The Larger than Life of Lavatri Lavatory [End Page 199] Spewhack (chapter titled “My Collected Phonecalls and Faxes”). While some... (shrink)

This study focusses on discourses on menopause through a critical reading of a selection of nine self-help books on the topic in the context of Dutch-speaking Belgium and the Netherlands. The aim is to explore whether self-help books constrain or facilitate the development of emancipatory discourses on menopause. We combine feminist critiques that identify the experience of menopause as a site of potential for revolt with insights from queer and critical new-materialist theorisation to probe the books’ emancipatory capacity. Our analysis (...) identifies three prominent discursive repertoires: a medical, psycho-therapeutic and spiritual repertoire. Anger and erotic power emerge as important themes, albeit differently framed dependent on the discursive repertoires that the books employ. We conclude that none of the books succeed in disrupting prevailing oppressive discourses that devalue ageing women. There are two important constraints, notably the books’ individualistic and depoliticised stance and their reductionist view on the biological body. As a way out, we propose a gaga feminist reading of menopause that looks at anger and erotic power as sites of ‘biopossibilities’ that may open space for overthrowing oppressive models of gender, sexuality and desire. (shrink)

Elselijn Kingma argues that Christopher Boorse’s biostatistical theory does not show how the reference classes it uses—namely, age groups of a sex of a species—are objective and naturalistic. Boorse has replied that this objection is of no concern, because there are no examples of clinicians’ choosing to use reference classes other than the ones he suggests. Boorse argues that clinicians use the reference classes they do because these reflect the natural classes of organisms to which their patients belong. Drawing on (...) a thorough exploration of how the disease osteoporosis is defined in adults, I argue that clinicians do indeed make choices about which reference classes to use in diagnosis. Clinicians use young adult reference classes to diagnose osteoporosis in elderly patients. They also use young female reference classes to diagnose osteoporosis in elderly males. Clinicians adjust their reference classes so that the diagnosis of osteoporosis reflects a person’s risk of sustaining a fragility fracture. The ethical intuition that people with the same risk of fracture should receive the same diagnosis overwhelms the naturalistic intuition that reference classes should reflect natural classes of organisms of uniform functional design. Clinicians construct a variety of reference class types, including pathological reference classes and epidemiological population-specific reference classes, to serve this ethical intuition. I show how clinicians use several reference classes at once so that they can more accurately predict risk of fracture. Ultimately, the reference classes chosen and used in medical practice are quite different from those proposed in naturalistic philosophy of medicine. (shrink)

Si l’on possède peu de témoignages sur la manière dont les femmes du XIXe siècle ont vécu le vieillissement, les discours des médecins sur cette question abondent. La ménopause est décrite par eux comme une période particulièrement dangereuse qui, à l’instar de la puberté, bouleverse toute l’économie de la femme. Au nombre des maladies qui sont susceptibles de l’assaillir lorsque s’interrompt le mécanisme régulateur que représentait la menstruation s’ajoute la blessure narcissique que provoque la perte de sa féminité et l’entrée (...) dans l’âge de décrépitude. Plus encore, la femme perdant avec la faculté d’engendrer sa vocation sociale (la maternité), cette période, souvent qualifiée d’âge critique ou d’âge dangereux, s’annonce comme une véritable mort sociale. Privée de sa capacité de séduction, fragilisée par la révolution physiologique qui s’opère en elle, la femme, encouragée à se retirer d’un monde où elle ne peut plus briller, est plus que jamais assignée à la sphère privée. (shrink)

Recent feminist research suggests that individual women find menopause an inconsequential or positive experience overall. While recent aging scholarship also documents that contemporary individuals often define aging neutrally or positively, menopause may not resemble other aging processes in meaning and experience. The author argues that menopause, or reproductive aging, may be unique because of its reproductive and aging contexts. Data in this article are based on interviews with 45 middle-class, heterosexual, menopausal women in a midwestern state in 2001. Interviewees (...) propose that, upon menopause, they do not feel old. They explain these feelings by describing their widespread use of contraceptive technologies, greater enjoyment of sexual activity upon menopause, and parallels between menopause and menarche. As women in this sample place menopause within the context of previous reproductive experiences and compare it to other aging processes, they suggest that reproductive aging represents a “good old.”. (shrink)

L’invention de la ménopause au xixe siècle puis celle de l’andropause dans la seconde moitié du xxe siècle ont eu pour effet d’accroître la surveillance des médecins sur les corps féminins et masculins vieillissants et, plus spécialement, sur la sexualité de cette période de la vie. Or, si ce coup d’état médical a si bien réussi, c’est qu’il a tout autant bénéficié du soutien très actif des femmes que de l’incapacité des hommes à lui résister. C’est aussi qu’il s’inscrivait dans (...) le prolongement de très anciennes pratiques sociales qu’il légitimait. Et qu’on ne s’y trompe pas. Loin de se desserrer, l’étau s’est définitivement refermé. En effet, les hommes, qui ont longtemps tenté d’échapper maladroitement à cette surveillance, ont, aujourd’hui, fini par s’y soumettre, acceptant, de fait, tout le discours silencieux sur les défaillances de leur puissance virile qu’elle suppose. (shrink)

Past research finds that after menopause some women experience negative changes such as vaginal dryness, decreased libido, and decreased orgasm quality; very little research inquires about positive changes. In contrast, this study shifts the research focus from whether women experience menopausal changes to how women view any changes in sex life. Based on 30 in-depth interviews with heterosexual and lesbian women, the author finds that most women emphasize cultural and social issues, such as relationship status and quality, health, and (...) sexual history, rather than menopausal changes when they describe sex after menopause. However, she finds a difference by sexual orientation in how women handle problems in sex. The author concludes by discussing the implication of this research for future menopause and sex research; most important, she emphasizes studying sex in the context of women's lives rather than as a result of the biological changes of menopause. (shrink)

Although previous studies showed that women’s menopause-related symptoms varied in different ethnic groups and countries, and were affected by specific social and cultural factors, few studies have been conducted to explore menopause-related symptoms and its influencing factors in middle-aged women among ethnic groups in China. This study aimed to explore the characteristics of menopause-related symptoms and its influencing factors among Mosuo, Yi, and Han women in Yongning area of Yunnan province, China. A cross-cultural design by snowball sampling method was used (...) to recruit 208 women aged 40–60 from Yongning Township, Ninglang County, Yunnan province, China. The 11-item Menopause Rating Scale was used to assess menopause-related symptoms. Compared with Yi and Han women, Mosuo women were accorded the highest family status. Multiple linear regression analyses showed that ethnicity, age, family support, and family decision-making patterns were associated with the severity of menopause-related symptoms. Yi and Han women had more severe menopause-related symptoms than Mosuo women. Among the three groups, women living in “female-dominated” and “co-deliberated” households had significantly lower scores of menopause-related symptoms than those in “male-dominated” households. This study indicates that menopause-related symptoms vary among middle-aged women in different ethnic groups. A higher level of female status in the family and family support may be protective factors of menopause-related symptoms in middle-aged women. (shrink)

This article discusses the moment in which normative ideas about aging and reproductive embodiment became conceptually linked in the mid-nineteenthcentury medicalization of menopause. The reading centers on the first English book-length publication on menopause, written by E. J. Tilt in 1857, and Foucault’s concept of the medical gaze. I analyze mechanisms of observing, conceptualizing, and treating the body in relation to time and discuss their function in affirming and reworking social norms of age and gender. In doing so, I highlight (...) the political work implicit in contesting conceptualizations of female reproductive bodies, their age-specific pathologies, and directives of (self-)surveillance employed in discourses surrounding women’s reproductive health. (shrink)

This article offers a critical phenomenological analysis of prevailing myths of menopause. By drawing on Simone de Beauvoir's conceptions of myths that essentialize existence, we have analyzed contemporary TV series in which menopause is portrayed. We identified the following myths of menopause: the myth of the liberated woman, the unnesting (s)mother, the old, ugly, and sexless witch, the mild, wise, and uncarnal woman. We first describe these myths and analyze how they may be interpreted as marginalizing in various and sometimes (...) ambiguous ways. Then, we trace out two distinct ways in which some TV shows expose these myths as essentializing myths, which is important for allowing us to take a distance from them, and thereby to resist them. The first one is in line with what Beauvoir herself suggested as a fruitful dealing with myths: replacing mythical thinking with actual experiences. The second way is conceptualized on the basis of Irigaray’s thinking about mimicking myths. Such dealings with myths of menopause, we argue, may open the road to less marginalizing and more pluriform thinking about menopause. (shrink)

Menopause, with its physical and emotional changes, appears to be an inevitable road for women to travel. The moment of choice for women at menopause involves not only whether they will embrace the new self or try to cling to identities from earlier life but also how the society in which they live views women after menopause. Amongst other things, many African marriages face difficulties when the moment of menopause arrives. This situation is often characterised by a second marriage or (...) a situation where husband and wife no longer share a room. Whenever this happens, it testifies to the idea that the sole purpose of marriage amongst African people is procreation - hence, when the period for that is passed, the bedroom setup changes. This is one of the ways in which senior women are deemed unfit for sexual encounters, a gender-equality concern. This article aims to unveil and discuss how some Africans use menopause as an excuse to exclude women from sexual intercourse, and how pastoral caregivers can help in such situations. (shrink)

Osteoporosis, a disease of bone loss associated with aging and estrogen loss, can be crippling but is ‘silent’ prior to bone fracture. Despite its disastrous health effects, high prevalence, and enormous associated health care costs, osteoporosis lacked a universally accepted definition until 1992. In the 1980s, the development of more accurate medical imaging technologies to measure bone density spurred the medical community’s need and demand for a common definition. The medical community tried, and failed, to resolve these differing (...) definitions several times at consensus conferences and through published articles. These experts finally accepted a standard definition at an international consensus conference convened by the World Health Organization in 1992. The construction of osteoporosis as a disease of quantifiable risk diagnosed by medical imaging machines reflects contemporary trends in medicine, including the quantification of disease, the risk factor model, medical disciplinary boundaries, and global standardization of medical knowledge. (shrink)

John F. Post argues that physicalistic materialism is compatible with a number of views often deemed incompatible with it, such as the objectivity of values, the irreducibility of subjective experience, the power of the metaphor, the normativity of meaning, and even theism.

Ce travail traite des effets psychiques de la ménopause chez certaines femmes. L’auteur stipule que, bien qu’il engage principalement le corps, ce phénomène constitue une période propice à l’éclosion de diverses formes d’expression psychopathologique. Le sujet, abordé à partir d’une réflexion théorique soutenue par deux vignettes cliniques, a pour ambition de faire saisir que l’entrée de certaines femmes dans la ménopause peut induire un effondrement dépressif sous-tendu par une plainte singulière, celle de « ne plus pouvoir faire le ménage comme (...) avant ». Cette plainte renverrait ces femmes à la question du désir dans leur ménage, entendons « dans leur couple », et interrogerait les figures du narcissisme, du maternel, du féminin, etc. Ainsi, la ménopause dévoile les enjeux inconscients à l’œuvre dans la relation conjugale qui nécessitent d’être élaborés dans le transfert afin d’être sublimés. (shrink)

The menopause transition is associated with an increased risk of depressed mood. Preliminary evidence suggests that increased sensitivity to psychosocial stress, triggered by exaggerated perimenopausal estradiol fluctuation, may play a role. However, accurately quantifying estradiol fluctuation while minimizing participant burden has posed a methodological challenge in the field. The current pilot project aimed to test the feasibility of capturing perimenopausal estradiol fluctuation via 12 weekly measurements of estrone-3-glucuronide (E1G), a urinary metabolite of estradiol, using participant-collected urine samples in 15 euthymic (...) perimenopausal women ages 45-55 years. Furthermore, it aimed to correlate E1G fluctuation (standard deviation across the 12 E1G measurements) with weekly mood and cardiovascular, salivary cortisol, and subjective emotional responses to the Trier Social Stress Test (TSST) at weeks 4, 8 and 12. Protocol acceptability and adherence was high; furthermore, E1G fluctuation was positively associated with anhedonic depressive symptoms and weekly negative affect. E1G fluctuation was also associated with increased heart rate throughout the TSST as well as higher levels of rejection, anger, and sadness. E1G fluctuation was not significantly associated with TSST blood pressure or cortisol levels. This study suggests a feasible method of assessing estradiol fluctuation in the menopause transition and provides support for the hypothesis that perimenopausal estradiol fluctuation increases sensitivity to psychosocial stress and vulnerability to depressed mood. (shrink)

Although there are many possible ways of understanding menopause, it is the notion of menopause as hormone deficiency that currently dominates. How is it that this account remains prevalent rather than some alternative understanding of menopause? This question is explored through the employment of a framework informed by both actor network theory and symbolic interactionist studies. The author exploits the common ground shared by these two conceptual approaches to analyze how practices generate and reify particular kinds of knowledge about menopause. (...) The analysis is situated within Australian menopause clinics and explores several key contemporary practices of these clinics to show how the particular understanding of menopause as hormone deficiency is generated and stabilized. The study stresses the knowledge/practice nexus and emphasizes that meanings are not given in advance but are generated through practices. In particular, the focus is on the interactions of the social and the material entities of menopause clinics and how through these interactions the understanding of menopause as hormone deficiency is produced. (shrink)