| Summary: | In this dissertation, I look to contemporary menopause management in the Southwest, United States, as an ideal case study of the 'real world' negotiation of a widespread contemporary conundrum--characterized by discourses of risk, proliferation of information and choice, chronic doubt, and personal responsibility for decision-making. While there have been previous studies of menopause in the US, this circumstantial ethnography seeks to understand contemporary menopause management in an era characterized by a massive shift in the biomedical risk discourses about menopause, the explosion of therapeutic choice in a burgeoning pluralistic health care environment, and the broad expansion of women's identities, body projects, and life priorities over the last several decades.I report on fourteen months of ethnographic fieldwork conducted in 2007 and 2008 with menopausal women and health care providers in the southwestern US. Research components included ethnographic interviews (N=60) and focus groups (6 groups with 27 participants) with midlife women, interviews with health care providers across a range of therapeutic modalities (N=20), and observation of emerging discourses of menopause in science, media and marketing.This dissertation illustrates that contemporary menopause management is a recursive process characterized by the ongoing re-evaluation of the impact menopause is having on one's life--in context. Participants described the unfolding of the lived-experience of menopause over time--even years beyond the end of menstruation. Risk discourses are not embodied en masse but reflect the concerns most salient in women's lives. While women access various expert and lay resources, they favor personal experts--sources deemed professionally sound and personally relevant--and their own embodied knowledge. For their part, health care providers described themselves as "normalizing" menopause and practicing patient-centered care aimed at empowering women to make their own decisions about how to manage menopause. Lacking an ideal choice, women make provisional treatment decisions that resonate with their current menopausal subjectivity. Despite abundant options, menopause management is increasingly stratified, with some able to access more information resources and afford more extensive decision-support. Among women with severe symptoms, bioidentical hormone therapy--productively positioned between biomedicine and complementary/alternative medicine--has emerged as a popular harm reduction strategy.
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