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Menopause and Hormone Therapy

But it took more than ads in medical journals to create a shared view of menopause as a medical problem that always needed treatment.  Seaman explains that this shift was accomplished by marketing estrogen as “replacement” for hormones lost as women aged and their menstrual cycles came to an end.  Messages aimed directly at women started to percolate through popular culture in the 1960s, with Dr. Robert A. Wilson’s book Feminine Forever the best-known example.  (Evans and Company, 1966).  Wilson claimed that menopause caused a precipitous decline in women’s overall health, sexuality and mental state and that estrogen was the only cure.  “A woman is not “complete” unless she takes hormone replacement pills.  She will be “condemned to witness the death of her own womanhood.”  She cannot be “forever feminine” unless she takes hormone-replacement therapy.” (Seaman, page 55, quoting Wilson)  Wilson’s descriptions of menopausal women suffering from “living decay” and being in a “vapid, cow-like state” certainly offended some women, but many more absorbed the message that menopause must be treated. 

As Seaman tells the story, the “menopause needs medicine” mantra continued, albeit with ups and downs, until the day in July 2002 when women all over the country heard that Prempro caused more harm than good with long-term use.  In the 30 years following the publication of Feminine Forever a series of medical benefits had been claimed for menopausal hormone therapy.  Women were told that estrogen prevented fractures, heart disease, and possibly even Alzheimer’s – what they weren’t told was that studies hadn’t proven any of these claims.  There were always some studies that could be cited to back up a doctor’s claim that hormones helped menopausal women age more healthfully.  At one point there were over a dozen studies that seemed to find an association between using hormones and experiencing fewer heart attacks.  But Seaman points out that that the right kind of studies, those that were able to sort out the influence of the hormones as opposed to the influence of the health-conscious lifestyle of the women using hormones weren’t even begun until the 1990s, and even then only at the insistence of skeptical activists. 

When the Women’s Health Initiative results were announced, they completely undid the culturally constructed view of menopausal hormone therapy.  The news media coverage at the time focused on the fact that hormones didn’t prevent heart disease or Alzheimer’s and that they increased the risk of breast cancer and blood clots.  What didn’t get as much attention was the finding that women in this study experienced none of the quality of life improvements that have been advertised for over 60 years.  Women didn’t have more energy, better sex, or improved mood.  So much for the happy, healthy older woman waltzing with her adoring partner! 

In The Greatest Experiment, Seaman shows us that what had been commonly "known”, that women need to replace the hormones lost through menopause to be healthy and enjoy life, wasn’t really knowledge, but spin.  She acknowledges that some women do experience problems with menopause, and rightly credits early estrogen researchers with good intentions.  But she uses this story, which she aptly describes as a decades-long experiment on women without their consent, to illustrate the need for women to know as much as possible about the drugs and medical procedures being recommended to them.

Woven throughout the history of menopausal hormone therapy, Seaman tells another estrogen-related story, that of the development and introduction of oral contraceptives. 
The FDA approved the first oral contraceptive in 1960 and this pill soon provided Seaman with experiences similar to the one she had with her Aunt Sally.  By the early 1960s, Seaman was a writer for for Dr. Joyce Brothers, the TV psychologist.  “We were swamped with questions and comments on Enovid, the first oral contraceptive.” (Page 119)  Over the next few years, as Seaman checked out the science, she became convinced that there were risks and side effects of birth control pills and that women weren’t being given this information.  As a result of her work, Senator Gaylord Nelson began hearings in January 1970  “to explore the question of whether users of birth control pills are being adequately informed concerning the pill’s known health hazards” (Page 124).  By that time, the early high dose pills had been removed from the Health Service formulary in Great Britain and replaced with safer low dose pills, but they were still being marketed in the United States. 

Nelson’s plan for the hearings was to call the drug companies to task for their disregard of women’s right to know, and to make studies of the effects of the pill better known.  However, Alice Wolfson and other women from D.C. Women’s Liberation changed all that.  “Suddenly….there was a disturbance from some women in the audience.  Someone asked, “Why are there no patients testifying at these hearings?”  When I turned to check out the disturbances, so did the rest of the people at the press table…who quickly shifted their attention…to the Wolfson women committing civil disobedience right there in the Senate, presenting their spontaneous testimony based not on scientific research but on their own life experiences.” (Page 131-132)

Direct action inside a Senate hearing room was unheard of in 1970 and immediately made news.  Protests at the pill hearings were reported on the nightly news that night and in major media around the world in the weeks following.  Seaman describes the result, “So successfully did D.C. Women’s Liberation make its case that hearings on medical topics that excluded testimony from patients would soon become a thing of the past.  But the Boston Tea Party of the women’s health movement went far beyond establishing a patient’s right to testify before Congress.  It led to the opening up of consumer access to information on all prescription drugs, to patient participation on FDA committees, and it helped to determine how to move forward with NIH and other government clinical trials….Ultimately, the group succeeded in shifting some power from entrenched interests to ordinary people.” (Page 134)

At this point in the book Seaman is describing not only her beat as a journalist, but her own involvement in founding a movement of which both she and I are a part.  The National Women’s Health Network sprung from the work of Seaman, Alice Wolfson and others, and continues in their spirit to this day.  In The Greatest Experiment, Seaman tells the stories of menopausal hormone therapy and oral contraceptives with the juicy details of an insider and the biting analysis of a feminist critic.  By sharing these stories, Seaman tells us not only how women’s health has been poorly served by the mythology of estrogen, but also how we can undo the harm done and create a better, healthier future for all women. 

Companion Pages:  1  2  3 

Written by: Our Bodies Ourselves. Special thanks to Amy Allina of the National Women's Health Network.
Last revised: April 2007

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