Negotiating competing discourses: the decision to take menopausal hormone therapy following surgical menopause

The aim of this study was to examine women's reports of negotiation and decision-making regarding use of menopausal hormone therapy after hysterectomy. Women who have experienced surgical menopause have more intense menopausal symptoms than women who have natural menopause and are often prescribed menopausal hormone therapy. Over the past decade acceptance of use of menopausal hormone therapy has been challenged by publications indicating its associated risks. Foucauldian discourse analysis was used to examine the discourses influencing women's experiences of early menopause precipitated by surgery and their decision-making regarding the use of menopausal hormone therapy. The project investigated via semi-structured interviews the perceptions and experiences of 30 New Zealand women aged 45-65 years who had undergone surgical menopause. The predominant discourses within which the participants' descriptions of their experience were embedded were: (a) new public health, (b) medical, and (c) lay moral judgment. Their health keeping/management practices were influenced by moral imperatives for quality of life, managing risk, and taking care of oneself. The use of menopausal hormone therapy for surgical menopause provides an example of the infiltration of public health discourse into lay judgments and influenced people to identify potential lifestyle problems and direct them to medicine and pharmacology as moral imperatives; and how women resist these discourses in various/particular ways.