Whose menopause revolution? Investigating the UK’s ‘Davina effect’ and the contemporary menopause market

Abstract

Having made two documentaries about menopause, broadcast on Channel 4 in the UK 2021 and 2022, enduringly popular British TV presenter Davina McCall’s films are perceived to have had such a social impact that she now has the rare distinction of having an ‘effect’ named after her. The first film, Sex, Myths and the Menopause, is credited with diminishing the stigma historically surrounding menopause, while extolling the benefits of Hormone Replacement Therapy (HRT) for some to treat menopause symptoms. Hence, when requests for HRT spiked after the first film, ‘the Davina effect’ was adopted by the media to explain the widespread ensuing HRT shortage. This article is not focused on interrogating the films themselves but unpacking the media narrative that followed in the uses of the term ‘the Davina effect’. Its corpus comprises UK press coverage of the ‘menopause revolution’ and of the Davina documentaries; textual analysis of the films; and testimonies and research drawn from the medical and health professions, while utilising existing media and cultural studies paradigms to provide conceptual context, situating the ‘Davina effect’ as the latest novel entry in a long-standing history of media effects debates. While the films have been praised for bolstering a new era of menopause awareness, this article considers how ‘the Davina effect’ instantiates and services how the so-called ‘menopause revolution’ (Gordon, 2021) has evolved largely in neoliberal terms, regularly centring the need to respond to the perceived crises of middle-class white women, rather than a more intersectional and inclusive conception of menopause. Furthermore, it apportions knowledge, fear and blame around HRT shortages in a manner which deflects attention from the larger economic, political and cultural contexts that have nurtured the ensuing alarm. Yet, importantly, the Davina effect may also facilitate a transgressive image of menopausal women as determinedly contesting their marginalisation.

I open this article, in an uncommonly anecdotal fashion given its academic context, with a 2022 appointment at a UK doctor’s surgery – my own, in fact. The doctor asks me what I do. ‘I teach at a university’, I share. ‘Oh, what subject?’. ‘Film and media’, I say, ‘Oh, how interesting!’ they reply, animatedly. ‘Actually, you might be interested in my current project’, I pipe up. ‘It’s about menopause and the media’.

They stop. ‘Hmmm’. Their tone and demeanour changes, from seeming curiosity to something more suggestive of exasperation. ‘Well, you need to look at what those Davina McCall documentaries have started, the amount of people coming in now thinking they know about HRT’. ¹ I store this unexpected moment away for future scrutiny and reflection, sensing that in it I have stumbled on a nugget of something meaningful for my work. And though I have inevitably paraphrased them here, I find myself returning to this doctor’s sentiment and frustration recurrently while undertaking this research. Here, a UK doctor shares with me that a UK TV documentary has had a tangible effect on their work in a regular GP (General Practitioner) medical practice. And as this research has continued, I have come to understand this moment as one of the multifarious but assuredly under-examined instances of the phenomenon this article is concerned with – namely, ‘the Davina effect’.

For, having made two documentaries about menopause broadcast on Channel 4 in the United Kingdom on 12 May 2021 and 2 May 2022, long-standing, enduringly popular British TV presenter Davina McCall’s ² films are perceived to have had such social impact that she now has the rare distinction of having had an ‘effect’ named after her. To help contextualise this turn of events, it is germane first to recall Channel 4’s unique position in the UK television landscape. As ‘a publicly-owned and commercially-funded UK Public Service Broadcaster (PSB), with a statutory remit to deliver high-quality, innovative, alternative content’ (Channel 4, n.d.), it has a reputation for commissioning often ‘edgy’ or bold programming with a quality PSB impetus, even while answering to commercial and populist imperatives. It is striking, then, that in their 2021 annual review, the channel showcased the first of the two documentaries – Davina McCall: Sex, Myths and the Menopause – as a prized production in delivering that year’s ‘Remit Performance’, incorporating a full-page photographic portrait of McCall, smiling and looking directly at the camera against a backdrop of a chilly British seascape, in a scene taken from the documentary’s location filming. Over the page, it declares, ‘At its most impactful, Channel 4’s content exposes the truth and acts as a powerful catalyst for change’ (Channel 4, 2022: 48–49) (my emphasis) – thereby clearly positioning McCall’s film as unequivocally making good on this ambitious intention. Detailing the cultural shame that has long met menopausal women ³ on reaching the cessation of menstruation, and tracing the psychological and physical symptoms this transition may bring (potentially including anxiety, vaginal atrophy and ‘hot flushes’ in peri- or post-menopause too), the film generated notable media attention. Watched by 2.5 million people including 14% of UK women aged 45-54 (Channel 4, 2022: 63), it met with a lively and frequently favourable reception. This was in response both to how McCall candidly shared her own debilitating menopause transition, revealing that she turned her life around by embarking on Hormone Replacement Therapy (HRT); and furthermore, to the forthright way the film exposed what it held to be the unforgivable remissness of the regular medical profession to better support those in menopause, and understand and prescribe HRT. Such was its success that it was followed a year later by Davina McCall: Sex, Mind and the Menopause. And as I trace below, it is even before this second broadcast makes it to screens that the term ‘the Davina effect’ first appears, the multiple ramifications of which this article scrutinises as crucial to understanding how the UK menopause market has evolved.

I use ‘market’ here to incorporate not only economic interests, from Big Pharma and private healthcare to supplements and self-help guides, but a cultural landscape newly attuned to offering information and extending awareness of menopause, all of which is, I argue, widely enmeshed in neoliberal discourses. Within this, the increase in HRT prescriptions seen in the United Kingdom in recent years and discussed below should be contextualised in part by the introduction in 2015 of the UK’s first National Institute for Health and Care Excellence (NICE) clinical guidelines on diagnosing and managing menopause. Addressing a need to ‘provide clarity on the benefits and risks of taking HRT’, the NICE (2015) press release on launching the guidelines spoke too of the desire to ‘empower women’ to seek help for menopause symptoms from their healthcare professionals. But quite beyond the introduction of the NICE guidelines and its place in tracing the menopause market, the growth of menopause awareness and commercialisation through menopause branded products, ‘relief’ and support has in recent years become increasingly visible across multiple providers and industries, expanding further with ‘the Davina effect’. Since officially launching in the United Kingdom in October 2021, for example, the GenM ‘MTick’, designating ‘the world’s first universal shopping symbol to signpost menopause-friendly products’, thereby ‘transforming the shopping experience for the menopause audience, delivering choice, trust and respect to an exponential market opportunity’, at the time of writing indicates 68 partner ‘brands, retailers and manufacturers’ on its website (GenM, n.d.). If, as Guardian writer Eva Wiseman observes, we have reached a point where ‘The menopause market has well and truly been tapped’, being worth an annual $600bn worldwide, and if ‘the menopause revolution’ commenced when ‘people like Davina McCall’ started ‘discussing the impact of menopause’ (Wiseman, 2022), then it becomes imperative to interrogate just how the Davina effect may have affected shifting perceptions, representations and experiences of a major transitional life stage that 51% of the population will undergo.

In essence, ‘the Davina effect’ has been coined by the UK media as a neat but pleasingly newsworthy explanation for events shortly after the first broadcast and reverberating still. This period saw a startling deficit in the pharmaceutical supply chain, such that reports then and recurrently since 2022 have adopted ‘the Davina effect’ to account for a UK-wide shortage of HRT ⁴ (see, e.g. Khan, 2022; Owen et al., 2022; Partridge, 2022; Woolcock, 2022 also Bryant, 2022). The term points, then, to how a notable spike in HRT prescriptions can be traced to the period following the first documentary, bolstered by the second too, in which the films had not merely rehabilitated but positively extolled the merits (for some) of HRT, two decades after HRT prescribing had abruptly slumped. Its calamitous downturn was prompted by the alarming findings of the US-based 2002 ‘Women’s Health Initiative’ (WHI), which McCall’s film now unravelled to revisit the benefits – and, crucially, the safety–of HRT. Over time, the WHI’s research has become infamously understood as misleadingly linking HRT to a significantly increased risk of breast cancer, resulting in its seismic abandonment (see, e.g. British Menopause Society, 2012; Currie, 2023). Dismantling this history, McCall’s documentaries are credited with shining a spotlight on what they frame as the potentially, even frequently, transformative powers of HRT, galvanising women to demand HRT treatment after years of its being under-prescribed and misconstrued as universally unsafe.

Thus, the documentaries are ubiquitously understood as marking a signal shift in what has been framed by the UK media and beyond as a national ‘menopause revolution’ (see also, e.g. All Party Parliamentary Group on Menopause (APPG on Menopause), 2021; Ducourtieux, 2022; Gordon, 2021), in which the films are regarded as undeniably instrumental in the resurgence of HRT. Writing for the British Medical Journal a year after the first Davina documentary in May 2022, Jacqui Wise confirmed that Department of Health and Social Care statistics show ‘demand for HRT has risen 38% in the past seven years’ (Wise, 2022), a period including but commencing some time before the first documentary in May 2021 (note again here the introduction of the NICE guideline on menopause in 2015). But within this timeline, analysis of data by the NHS Business Services Authority, for example, showed that between February 2021 and February 2022, ‘Oestrogel prescribing increased by 76%, Estradot by 74%, Lenzotto by 1106% and Sandrena by 146%’ (Wise, 2022), a picture that gives further statistical context to the shortages that followed. News stories sharing tales of the despair and panicked measures angered women had been pushed into over shortages soon burgeoned. At one level these might be read as expressing justifiable concern at the impact of shortages. More problematically, I argue, they also readily lent themselves in some quarters to repurposing tired tropes of middle-aged women as prone to erratic and troublesome behaviour. The Daily Mail told how, ‘Some have turned to the black market or even meeting up in car parks to swap medication’, with an alarming headline announcing that their unavailability ‘[may] force women to become drug mules by travelling overseas to buy vital supplies’ (Leatham and Huskisson, 2022); while Sky News reported ‘desperate women’ were being forced ‘to swap the drugs with strangers in car parks or buy them on forums’ (Barnfield, 2022). On examining data for England in the financial year 2021/22, The Nuffield Trust found a 42% increase in HRT prescriptions compared to the previous year, observing that campaigners ‘including notably the broadcaster Davina McCall’ have been decisive in this (Appleby, 2022). Nevertheless, one of the issues sidestepped by the undoubtedly enthralling picture all this presents – where a TV documentary issues a call-to-arms to disserved women resulting in an observable shift in behaviour and public outcry–is that HRT shortages in the United Kingdom, albeit to a lesser degree, predated the films having been reported since 2019 (Wise, 2022).

This article is not focused on interrogating the films themselves. Rather, in what follows I unpack the narrative described above to interrogate the multiple interests informing ‘the Davina effect’ and the elevated currency it has come to hold in its specific socio-cultural contexts. This analysis underscores how scrutiny of its use may critically inform a wealth of interdisciplinary fields, including television, health, and ageing studies, utilising intersectional feminist cultural studies and media studies frameworks to examine a breadth of diverse evidence. My corpus comprises UK press coverage of the ‘menopause revolution’ and of the Davina documentaries; textual analysis of the documentaries; and testimonies and research drawn from the medical and health professions, while utilising existing media and cultural studies paradigms to provide conceptual context. Here I situate the ‘Davina effect’ as the latest novel entry in a long-standing history of media effects debates. I trace how the Davina effect narrative has encompassed and been shaped by multiple ‘players’, incorporating the UK media, politics and celebrity culture; the NHS and private healthcare provision; the pharmaceutical industry; television and its audience/s, and – crucially–that generally most unremarkable, undistinguished, negligibly interesting figure, who here becomes the focus of disconcerted attention: the perimenopausal/menopausal/postmenopausal woman. When does the ‘Davina effect’ appear and where, and why does this matter? How might we interrogate these documentaries and their reception to better grasp how they are perceived to have had a demonstrable, landmark influence on behaviours among the wider public – especially again regarding (predominantly) middle-aged women? In asking these questions, I argue ‘the Davina effect’ instantiates and services how the ‘menopause revolution’ has largely developed within the terms of a neoliberalist project. Within this, I argue, it regularly centres the need to respond to the perceived crises of middle-class white women, rather than a more intersectional and inclusive conception and exploration of menopause. Further, it apportions knowledge, fear and blame around HRT shortages in a manner which deflects attention from the larger economic, political and cultural contexts that have nurtured the ensuing alarm, and facilitated the menopause revolution taking the shape it has. When one looks at the Davina effect other than as a story about chaos ensuing from discontented middle-aged women getting fired up by a TV show, what other ways of understanding this media moment and the circumstances preceding it might come to the fore? And what does it tell us about attitudes to ageing women, women’s health, and changing cultural conceptions of menopause increasingly evident in the United Kingdom and beyond?

‘First, I was frustrated, then I was tearful . . . but then I got angry’: Sex, Myths and the Menopause rouses the menopause revolution

Recent work on the explosion of UK media and wider cultural attention paid to the menopause (Jermyn, 2023; Orgad and Rottenberg, 2023b) has traced how McCall’s first documentary is pervasively framed as central to rupturing the silence that once met menopause, being widely received in the press as ‘groundbreaking’ (O’Connor, 2022; Sigee, 2021) and ‘[sparking] a vital discussion on ending the stigma that still exists around something half the population go through’ (O’Connor, 2022). Reflecting in the Guardian on its impact, Rachael Hall observed that consequently, this ‘game-changing documentary. . . resulted in what some doctors have called a ‘Davina effect’ among patients whose midlife struggles suddenly made sense’ (Hall, 2022). Note that in this account, ‘the Davina effect’ is not merely about subsequent HRT shortages (though Hall like many others does see McCall as instrumental in this), but also about its role in increased public awareness of menopause and its potential symptoms, not least among menopausal women themselves (see also Wise, 2022). Relatedly, writing previously in the Journal of Aging Studies, I have adopted the term ‘the menopausal turn’ to describe the recent ‘unprecedented period of pronounced cultural conversation and promotion around a newly inflected era of menopause awareness. . . identified in operation throughout multiple and intertwined cultural spaces, including education, politics, medicine, retail, publishing, journalism and more’ (Jermyn, 2023: 1). While the Davina documentaries are undoubtedly part of this, the menopausal turn has also included, for example, the launch of the first ‘Menopause Café’ in Scotland in 2017 (now an international movement), Diane Danzebrink’s landmark #MakeMenopauseMatter campaign launched in October 2018, and a Private Members Bill to end prescription charges for HRT in England (Jermyn, 2023: 2) – much of this predating the Davina films. The documentaries must thus be situated both as one component of a larger, changing, multiply inflected landscape, and as having particularly visibly augmented and facilitated this landscape. In Orgad and Rottenberg’s lucid analysis, the first film was ‘one of the constitutive cultural texts of what we call the menopause moment’ (2023b: 3), while in instructive earlier work examining UK news coverage of menopause from 2001-21, they find one of six ‘peaks’ of coverage in this two-decade period comes precisely in May 2021 – the month Sex, Myths and the Menopause was broadcast (2023a: 11).

While the menopausal turn was very much underway by the time of Sex, Myths and the Menopause, then, the documentary resonated powerfully within it. To understand why, it is necessary to recognise multiple coincident contexts, and acknowledge, for example, the labour of numerous others, such as menopause campaigner and Labour Member of Parliament Carolyn Harris, and a political and economic moment increasingly preoccupied with encouraging women to stay in the workplace longer (Orgad and Rottenberg, 2023a: 13). Nor should one overlook the earlier celebrity menopause television documentaries broadcast by the BBC made by presenters Kirsty Wark (The Insiders’ Guide to the Menopause, 2017) and Mariella Frostrup (The Truth About. . . The Menopause, 2018), since all this laid significant groundwork shaping a cultural climate primed for the impact of the McCall films, while cultivating a landscape in which the menopausal testimonies of white women celebrities have courted most media attention (McCall, as with Wark and Frostrup and many other famous UK public commentators, is white). In addition, it is important to understand the particular appeal of McCall herself, who first came to public attention as an MTV presenter in 1992. Since then, she has presented numerous prime time TV series including the original UK Big Brother (Channel 4, 2000-10) and most recently the dating reality show My Mum, Your Dad (ITV, 2023-), becoming known for her forthright and warm-hearted manner, while also forging a successful following as a fitness guru (see Jermyn, 2023: 5-6). In keeping with her personable appeal, Sex, Myths and the Menopause opens with McCall’s own frank disclosure about the confusion and fear that met her transition into perimenopause, her frustration, tears and anger at how ‘Women across the UK have been badly served by science’, and the subsequent relief and liberation from this that came with obtaining HRT via a private health clinic. Guided by her ‘relatability’, the film brings together heartfelt and often traumatic personal menopause testimonies and critical information garnered from celebrities, public figures, health professionals, and ‘ordinary women’. For journalist Rachael Sigee (2021), when reviewing the first film, as for many other viewers, ‘McCall was the perfect anchor: empathetic, warm, honest and straight-talking’. These same qualities bolstered her subsequent consolidation as a leading figure in the UK’s ‘Menopause Mandate’, a not-for-profit company and high-profile ‘coalition of campaigners’ comprising ‘women, campaigners, politicians, menopause experts, celebrities and journalists’ lobbying for improved menopause education, and more affordable and accessible HRT (Menopause Mandate, n.d.).

However, even while it critiques the shortcomings of a UK healthcare system which provides just 97 specialist menopause centres for a menopausal population of 13 million, the film is also enmeshed in individualist neoliberal and postfeminist discourses common to how the menopause revolution is taking shape (Jermyn, 2023). Its address is simultaneously one that speaks to systemic injustices collectively enacted on menopausal women through the double-bind of sexism and ageism, and one in which menopausal women are urged to step up, empower themselves by taking ownership of their menopause journey, and embrace menopause as an opportunity to thrive anew. In the first film, for example, former schoolteacher Karen Arthur shares how she felt she had no choice in perimenopause but to quit her demanding job when she was beset by hot flushes and found ‘I kept forgetting things. I thought I was going mad’. (‘I was the same!’, McCall responds animatedly and empathetically). By the end of her story, though, it is underlined by McCall’s voiceover that through menopause Arthur was able to flourish, reinventing and rediscovering herself by leaving teaching and switching to the invigorating field of fashion design. Indeed, a recurrent facet of a successful menopause posited by these documentaries is the imperative to prosper professionally in/through it (see also Orgad and Rottenberg, 2023b). And while gendered-ageism is undoubtedly a rampant workplace inequity that hits menopausal women hard and is confronted by the films, decelerating professionally is never presented as a viable option. What Arthur doesn’t talk about as a Black participant in the film, as she does so powerfully elsewhere including on her social media as the founder and host of podcast ‘Menopause Whilst Black’, is how racial weathering compounded her menopausal symptoms (see, e.g., Arthur, 2020). There is insufficient space in the programme for exploring complex intersectional contexts that inform how menopause is experienced differently. This is despite research finding Black and Latinx people enter menopause earlier than their white counterparts, and that somatic experiences of menopause are embedded in socio-political contexts and the interaction of the biological and the social (De Salis et al., 2018: 520–521). ⁵

Later, in Sex, Mind and the Menopause, three women undertake to film video diaries over three months on beginning to take testosterone, supplementing their regular HRT prescription of oestrogen/progesterone (since testosterone is not currently included in standard NHS menopause treatment). The effects are presented as akin to undergoing a makeover – a paradigm conceptualised by Rosalind Gill (2007, 2021) as one of the defining sensibilities of postfeminism, enmeshed in neoliberalism for its insistence on ‘an entrepreneurial and ‘responsibilized’ subject’ (p. 10). In this vein, as if in the climactic resolution of the ‘big reveal’ at the end of a makeover, testosterone proves ‘transformational’ in the words of one woman, with another declaring, ‘I’ve got my va va voom back!’. Similarly, for Orgad and Rottenberg (2023b), while Sex, Myths and the Menopause ‘invokes key feminist terms, such as struggle and liberation, and discusses crucial structural conditions that underpin the continued stigma and shame around menopause’, it ultimately wrestles a discordance between the ‘structural inequalities’ it highlights and an ‘emphasis on individualised and privatised solutions’ (p. 4) (where, for example, the film applauds the private health clinic that facilitated McCall’s life-changing access to HRT while also noting the inadequacies of the NHS). At the end of the second film, McCall shares, ‘I never saw myself as an activist’, as she reflects on some of the striking changes in menopause provision she and others have helped effect in the preceding months. In this aspirational, neoliberal ‘self-starting’ narrative of growth and reconstruction, her admission underscores a further regenerative midlife makeover, where viewers see how menopause has entailed an unexpectedly rewarding and fulfilling professional and personal reinvention for McCall herself. ‘This is where things change’, she asserts at the end. ‘Let’s start the menopause revolution’. But as noted above, it is just before this broadcast, providentially for pre-publicity, in the latter part of April 2022, that the first published reference to ‘the Davina effect’ has already appeared.

‘It’s the Davina effect’: from smashing taboos to ‘supply chain issues’

In unpacking the Davina effect, a logical line of enquiry is to identify when and where the phrase first appears in the public domain. Database searches point to its earliest use in the media on April 24 2022 in the (UK conservative tabloid) Mail on Sunday. The article centres on government plans to address the HRT shortage already underway, its unwieldy headline announcing, ‘Sajid Javid ⁶ to appoint an HRT tsar to fight shortage of medicine that helps ease menopause symptoms – and says role will emulate that of Covid vaccine chief Kate Bingham’ (Owen et al., 2022). Further down, however, a sidebar carries the rather punchier headline, ‘‘Davina effect’ smashed the menopause taboo’, where the copy provides a back-story, illustrated by a picture of a glamorous McCall in a vivid yellow one-sleeved cocktail dress at a red-carpet TV event:

HRT is in short supply thanks to increased demand in the past year driven by celebrity campaigns, political action and greater media coverage of the menopause, pharma firms say.

‘It’s the Davina effect’, said Tina Backhouse of Theramex, which supplies the HRT treatment Bijuva. TV star Davina McCall, 54, right, is credited with helping smash the taboo surrounding ‘the change’ in her 2021 documentary Sex, Myths and the Menopause (Owen et al., 2022).

The phrase then appears the next day in a Telegraph article leading on model/TV presenter Penny Lancaster’s incapacitating menopause story and current struggle to obtain HRT (Silverman, 2022); and, two days later, the Guardian, also reporting on the shortage, notes that, ‘Demand for HRT products surged by 30% in the month after the [initial] broadcast, according to Theramex, a global pharmaceutical company’, further ‘climbing by 130% during the second half of 2021’, such that ‘several HRT manufacturers’ had dubbed the huge surge in demand ‘The Davina Effect’ (Partridge, 2022) (my emphasis). Crucially, then, in two of the national newspaper articles first adopting the term one finds clear reference to Theramex as a story source. The company is described on its website as ‘a global speciality pharmaceutical company solely committed to supporting the health needs of women through every stage of life’ (Theramex, 2023). And Tina Backhouse, to whom the Mail on Sunday first attribute the term ‘the Davina Effect’, is their UK General Manager who joined them in 2020, ‘helping to establish Theramex in the United Kingdom as the largest supplier of HRT & Menopause Products’ (Theramex, 2023). Notably she has since become a regular participant in coverage of the menopause revolution, appearing alongside campaigning celebrities and politicians, joining the Menopause Mandate coalition and emerging as something of a ‘human face’ to some of the key Big Pharma interests behind the menopausal turn; like McCall, she has also frankly disclosed her own difficult personal story as a professional woman whose career was severely curtailed by debilitating menopausal symptoms (Al-Khalaf, 2023).

Further, following news that the second Davina menopause documentary would screen imminently in April 2022, the press reported that ‘HRT suppliers [were] braced for demand to rocket once again’ (Partridge, 2022; see also Bryant, 2022). And this fear was well-founded when, for example, through spring 2023 there was a serious UK shortage of progesterone. Furthermore, since Sex, Mind and the Menopause the Davina effect has also been charged with prompting surging demand for testosterone, after that film particularly suggested testosterone was neglectfully excluded from NHS menopause prescriptions despite being for some, as noted, ‘transformational’–even, in fact, comprising what the documentary calls ‘the missing piece’ in HRT. However, such were some objections to this claim that BBC Science Focus was moved to run a story entitled ‘Ignore the Davina McCall Effect: Why testosterone is not a menopause wonder drug’ (Griffin, 2023) (my emphasis). Here, Dr Michelle Griffin states in unequivocal terms that, ‘Medicine is evidence-based. . . Anecdotal accounts from celebrities, or anyone, should not be used to inform women on the correct medical treatment for them’.

Ways of seeing: the Davina effect/s and its contexts

More recently, the Davina effect entered the spotlight again in March 2024 following a highly divisive article published in leading medical journal, The Lancet, which cautioned against what it identified once more as the burgeoning over-medicalisation of menopause (Hickey et al., 2024). Noting that ‘In the UK, use of Menopausal Hormone Therapy (MHT) increased by around 60% between 2020 and 2022’, the article conjectured that ‘the reasons for this increased use are uncertain but might reflect the subtantial [sic] increase in media attention towards menopause’ (Hickey et al., 2024: 948). This comment was widely interpreted as implied criticism of celebrity menopause campaigners, as so visibly embodied by McCall, such that McCall took to Instagram on March 6 to refute the article. Rather than giving HRT a hard-sell, she insisted that her motive has been

to educate and support women through what can be quite a tricky period in their lives . . . we’re not pushing HRT, but people need to know that it is an option . . . stop arguing at all the celebrities and give us the information to give to everybody!

The furore that followed The Lancet publication gave pause to the Daily Mail to again observe McCall’s role in the booming numbers of HRT items prescribed in 2022/23, noting ‘experts have put the rise down to the ‘Davina effect’ and wider awareness of the menopause’ (Ely, 2024). But importantly, this article underlines a further pervasive lens through which the Davina effect is commonly interpreted, where is it imagined as not only serving a possibly constructive educative function; rather, it is also framed as exacerbating fear. Here, the piece observes that ‘celebrity “horror stories’ surrounding the menopause have “sensationalised” the topic, making middle-aged women “scared” about a biological inevitability’ (Ely, 2024; see also Lister, 2024). In the same vein, India Knight (2022) is one of several commentators to point to the cross-generational implications of this, observing ‘The HRT panic must be terrifying young women’, caught up in a climate rendering menopause a punishing condition to await with trepidation. Similarly, there are concerns that the menopausal turn more generally may be undermining middle-aged women, signalling them, in ways already noted above, as unstable and a potential workplace liability, and auguring dread of them/of ageing rather than bolstering empathy (Aljumah et al., 2023: 80; Jermyn, 2023). That the capacity to potentially disseminate both fear and knowledge can so readily co-exist suggests ‘the Davina effect’ is less comprehensible a conceptual entity than it might initially appear.

At an elementary level, those using and encountering the term will share a collective understanding that it signals how McCall and her films have been, in some way, influential, and the terminology has a history of similar precursory use in television and media, some relating directly to celebrities raising public health awareness. After UK reality TV star Jade Goody learned she had cervical cancer while appearing in 2008 as a housemate in the Indian series Bigg Boss, for example, her diagnosis and death in the public eye months later, aged just 27, was credited with prompting an extra 500,000 cervical smear tests that year, dubbed ‘the Jade Goody Effect’ (see, for example, Casey et al., 2013; Khan, 2022). Here, the ‘effect’ is observed to have a tangible positive outcome in increasing awareness of and testing for cervical cancer for a period, leading to a rise in the detection of cancer. But discussion of media ‘effects’ has frequently centred on concerns about potentially ‘negative’ or damaging media influence, and with it, audience vulnerability. ⁷ By way of example, perhaps the most visible and enduring TV effects debate in the past two decades has been ‘The CSI Effect’. As the number one TV fiction series in the world in its heyday, US forensic crime drama CSI: Crime Scene Investigation (CBS, 2000-15) and its associated spin-off series clearly belong to a very different mode of television to the Davina documentaries, and yet their two ‘effects’ narratives bear comparison. The ‘CSI Effect’ has been traced as originating in a 2002 Time magazine article, and eventually primarily denoted concern that since CSI, juries were becoming less likely to convict without overwhelming forensic evidence (Chin and Workewych, 2016). While subsequent research into the CSI Effect found ‘virtually no empirical evidence’ to substantiate it (Chin and Workewych, 2016: np) what was evident, however, was a familiar tendency to imagine TV viewers as easily suggestible. Indeed, the terminology of ‘effects’ is fundamentally disempowering to those seen as ‘effected’. It always creates an ‘other’ – media users that are vulnerable or susceptible to effects, vs those that are resilient or immune to them.

In this vein, ‘the Davina effect’ is commonly constructed as giving rise to irregular and sometimes panicked behaviour, as women both demanded greater menopause care and HRT access from their doctors and navigated serious resultant medication shortages. A GP in one Telegraph story shared that, ‘In the week after the Davina documentary, every woman I saw was for menopause and this was the same all over the country’ (Silverman, 2022); India Knight reported bewilderment at ‘stories about women bunking off work to track down their medication, going abroad to procure it, borrowing it from friends or buying it on social media’ (Knight, 2022); while the Guardian described how many women were ‘experiencing distress’ and some ‘risking serious side effects by using medication prescribed to others’ (Gregory, 2022). Strikingly, some 2022 news reports about HRT shortages merged the story with another significant health news headline from the period, following the April release of a Pharmaceutical Services Negotiating Committee (PSNC, 2022) briefing, in which its recent ‘Pharmacy Pressures Survey’ revealed three quarters of pharmacies had experienced aggression from the public because of medicine shortages (p. 1). On occasion, in some reporting, the latter statistic is presented as if it is the outcome of the former context, linking the stories so that it is implied that menopausal women are behind the rise in hostile behaviour. In The Times, then, the fact that ‘Women across Britain are struggling to find [prescribed HRT]’ is immediately followed by the news that ‘Two thirds of pharmacies report daily shortages, and three quarters of pharmacy staff say they have experienced aggression from patients as a result’ (Spencer and Crowther, 2022). A similar conflation is found in The Mirror, where the implicit relationship between the two stories is inverted, as the report notes in quick succession that 75% of pharmacy staff polled ‘had faced “aggression from patients due to medicine supply issues”’, then [HRT] ‘prescriptions in the UK [have] more doubled in the last five years but stocks are running low’ (Bagot, 2022). Yet when one reads the original PSNC (2022) report about the rise in aggression towards under-stocked pharmacists, there is no specific reference to HRT shortages whatsoever, and it is evident the problem is far more dispersed.

Women behaving badly: the Davina effect and menopausal outrage

What, though, if these women aren’t merely self-righteous or indignant, erratic or aggressive, as often implicitly seems in such reports; nor easily influenced, and vulnerable to basing healthcare choices on ‘anecdotal accounts from celebrities’ (Griffin, 2023)? Instead, what if these are women who have found a kind of fissure in this moment, through which they now convey what evidently is for many, cumulative years of being dismissed, belittled and sidelined in trying to express or seek help for menopause symptoms? The Davina effect here presents a tension, both enacting tired tropes of older women as unstable, and enabling glimpses of them as determinedly pushing back against cultural and institutional structures that marginalise them. Further, what if the Davina effect is adopted at times to frame the act of women reaching out for recognition or relief from the disregard they have met as being presumptuous, or overwrought, so that becomes ‘the story’–the conjured image of angry middle-class, middle-aged women agitatedly gathering in car parks to trade drugs proving effective as a wildly diverting picture? Consequently, the reporting examined here works to deflect attention from focussing more rigorously on, for example, ongoing shortcomings in the pharmaceutical supply chain across numerous medications predating the Davina films (where the impact of Brexit and a systemic failure to adequately predict demand using data are also key) (Wise, 2022); and further, a history of failure to sufficiently research, understand or promote women’s healthcare. Indeed, the picture of the troubled and troublesome middle-aged women that emerges over many of these reports falls neatly into established archetypes of female hysteria and older women’s volatility, in which women’s ‘emotional’ behaviour across the life course is governed by their unstable bodies. As De Vuyst and De Graeve (2023) note:

Older women’s anger and discontent are often depicted as out of control, wild and crazy, rather than acknowledged as a normal reaction to the injustices they face . . . Moreover, their subversive acts tend to be explained as the result of cognitive impairment or menopause, disarming their unruliness and reaffirming the status quo (p. 4).

At times, a sense emerges from this cumulative picture that it is verging on improper for older women to question their GPs regarding their menopausal care (or lack thereof), and that they should more properly show greater compliance in these encounters. This is an inference which chimes with the much-repeated complaint made by menopausal women, as heard in some of the personal testimonies shared in Sex, Mind and The Menopause, that their doctors proved consistently unsupportive of them when they sought help (see also Aljumah et al., 2023: 79)–for as De Vuyst and De Graeve (2023) note, older women’s ‘articulations of dissent are often overlooked, delegitimised and neglected’ (p. 3). Banet-Weiser and Higgins vividly interrogate the continued labour and high-stakes women must negotiate in laying claim to believability, with particular regard to contemporary mediation of sexual violence (see also Orgad and Rottenberg, 2023b: 7). They write, ‘an economy of believability involves representations, ideologies, labor, products, resources–and intersecting power hierarchies within all of these elements’ (Banet-Weiser and Higgins, 2023: 5). Thus, healthcare too constitutes another space where precisely such an economy has long existed, in which women’s pain and symptoms (frequently but not only regarding gynaecological and reproductive health) have gone under-treated and under-acknowledged by a profession which has primarily centred male experience and comprehension. If the reporting of menopausal women’s behaviour following the Davina effect starts from a baseline position of thinking middle-aged women are prone to be volatile and perhaps even a little ‘wild and crazy’, they need not be taken terribly seriously. Yet recent research by Rawan Aljumah et al. (2023) exploring postmenopausal women’s ‘attitudes and knowledge of the menopause’ finds they consistently reported one of the most difficult aspects of their menopause was precisely that GPs were not sufficiently knowledgeable about it (pp. 74–75; 81). Such findings exhort us to understand menopausal women not as ‘impaired’, but as credible subjects, and in essence to ‘believe women’.

Conclusion: whose Davina effect?

To more fully grasp the operations of the Davina effect, insights gleaned from analysis of ‘the CSI effect’–here in relation to polysemy – prove germane again. During the 2000s, as intrigue around the CSI effect burgeoned, research identified how in fact there were many CSI effects depending on where one looked – the ‘defendant’s effect’ versus the ‘prosecutor’s effect’, and so on (Chin and Workewych, 2016). And similarly, the Davina effect has been felt in manifold ways across manifold contexts. Nada Khan at The British Journal of General Practice, for example, reflected the Davina effect would prompt different responses among GPs: from those who received the documentaries as ‘GP bashing’, feeling ‘defensive’ or ‘angered’, to others who welcomed the films, and felt motivated to improve their menopause knowledge because of increased interaction with these patients (Khan, 2022). In either case, Khan observes, the Davina effect’s ‘[impact] on patient behaviour’ has ‘resulting consequences for healthcare professionals’ too (Khan, 2022). Elsewhere, business organisations anticipated the Davina effect would impact workplaces by prompting ‘an increase in demand for workplace menopause support’ (e.g. Employer News, 2022). Further, with regard to menopausal women themselves, passionate testimonies from them are amply available on McCall’s Instagram account. These women do not speak for ‘all women’ by any means. But they vehemently express gratitude for the understanding, knowledge, and call-to-arms the Davina effect has fermented, and it would be insupportable and belittling to them indeed to sideline or underestimate the strength of that feeling or the impact of this.

But while some observers applaud the new era of candour that McCall’s films have mobilised, one must probe further into who has or hasn’t reaped the benefits described in this roll call of gratitude. While Channel 4 may aspire, as noted, for its content to ‘act as a powerful catalyst for change’ (Channel 4, 2022: 48–49), crucially, the ripples of the Davina effect have not yet been universally felt by everyone who might stand to gain from having HRT. As noted above in relation to the concept of racial weathering and its interplay with experiences of menopause, menopause is an inherently intersectional phenomenon. Relatedly, research shows HRT has overwhelmingly been, and continues to be in its recent expansion, prescribed to white, middle-class women; research released in April 2024 examining data for 1.85 million UK female patients aged 45–55 found 5% of Black women and 6% of Asian women were taking HRT, compared to 23% of white women (Oppenheim, 2024). And NHS figures pertaining to the year following the Davina films underline that the rise in HRT prescriptions since the Davina effect was not evenly distributed nationally nor across all communities. In fact, statistics indicate the gulf between those regions that do/don’t access most HRT has grown since the Davina effect became a recognised phenomenon. As The Telegraph among others reported,

NHS figures show a clear link between affluence and access to HRT . . . Middle-class women across the South West are the most likely to access therapies . . . the NHS prescribing data, which covers the 12 months until September 2023, shows a widening gap in provision between the richest and poorest areas, suggesting that gains getting hold of HRT are mainly among the middle classes (Donnelly, 2023).

Even where it is not expressly acknowledged, then, reporting of the Davina effect while seemingly realising a ‘wider awareness of the menopause’ (Ely, 2024) still favours the stories and experiences of predominantly middle-class white women. The empowered vision conjured of menopausal women galvanised by the menopause revolution to demand more from their GPs does not sufficiently grapple with the classed, raced and differently gendered exclusions that belie this, nor does it scrutinise the differences socioeconomic status makes in attempting to leverage such conversations. To be clear, campaigners from Menopause Mandate including Mariella Frostrup and Tina Backhouse from Theramex and others, have been vocal in calling out the ‘socioeconomic chasm’ suggested by this prescribing data (Donnelly, 2023). But as with the Davina documentaries, which cannot carve a space to satisfyingly explore more of the nuances of different intersectional experiences of menopause, so too do these reports generally fail to materialise questions of why, for example, Black and Asian women have lower rates of HRT prescribing and how this is imbricated in histories of institutionalised racism, or how the current ‘health lottery’ (Donnelly, 2023) in the United Kingdom is sustained. ⁸

Finally, in the Davina effect, we see the same stakes and many of the tensions and contradictions characterising the wider menopausal turn (Jermyn, 2023): the easy reproduction of neoliberal values and discourse; the drive to keep ageing women both in the workplace and continually primed to ‘work on themselves’; the privileging of white, middle-class, cis-gender stories as core to grasping menopause experience; the somehow always present yet occluded sensation that a mighty money trail is driving the changing discourses around menopause as much as any commitment to improving women’s health. And we see in it too another chapter of cultural anxiety about wayward or vulnerable media consumers/TV viewers – here not easily malleable working-class patrons or exploitable teenagers, as often the case historically, but raging middle-aged, middle-class women. At a time when, rendered optimistically, a neoliberal position might have it that the move to extend ageing women’s working lives will lead to greater respect, independence, and wider social participation for some at least, the discourse of the Davina effect has in many ways worked in time-honoured fashion to discredit and undermine menopausal women as prone to erratic behaviour. As much as the Davina effect has been pitched by the media as a novel turn of events emerging from an unusually impactful TV documentary, it has nevertheless traded in gendered fashion at times in conservative tropes familiar from accounts of female hysteria. In this we see the reductiveness of centring ‘blame’ on any single factor to explicate why the menopause revolution has taken the shape it has, the necessity of interrogating just how so many of these factors are interlinked and service one another in a neoliberal climate, and the continued urgency of agitating for more diverse, inclusive and nuanced media accounts of the breadth of menopause experience, in the United Kingdom and, indeed, beyond.

Nevertheless, there lingers a pleasing kind of residue of the trope of the unruly woman in the reporting of the Davina effect, the spectre of ‘transgressive’ older women refusing to be fobbed off any longer by a cultural landscape that too readily considers them obsolescent. And while Aljumah’s et al’s survey of the lived experience of postmenopausal women carries with it the limitations of most research into menopause, as they note, having been overwhelmingly completed by white, highly educated women, it illuminates how these ageing women respondents are no cultural dupes. Of the six major recurrent themes that researchers identified as key among their answers, the final one is the issue of ‘the importance of the media’. Here, the women are seen to consciously grapple with media accounts of the menopause revolution and its impact – not merely constituting statistics in the Davina effect, then, but shrewdly asking of the media: ‘are they getting it right?’ (Aljumah et al., 2023: 80) (my emphasis).