Map of life expectancy at birth from Global Education Project.

Monday, July 18, 2005

Menopause is not a disease

What do I know about it, being as I will never experience it, but I'm going to talk about it anyway.

Everyone will remember that Hormone Replacement Therapy (HRT) was intensively marketed to women on the premise that it prevented the supposed negative effects of menopause -- in particular, the increased risk of heart disease and stroke that women face as they grow older. These benefits were initially observed in a cohort study called the Nurse's Health Study, but a later randomized controlled study called the Women's Health Initiative, and another study called the Heart Estrogen/progestin Replacement study, found just the opposite to be true. HRT also increases the risk of breast cancer.

Nevertheless, if you're one of those unfortunate people who watches television, you have no doubt seen the continuing Direct to Consumer Advertising for Prempro, the major HRT product, now marketed exclusively to combat symptoms of menopause. Thanks to the drug company lawyers worried about massive lawsuits, and an FDA now slightly more inclined to cover its ass, these ads say enough about the risks that at first I could not imagine they would persuade anyone to actually take the stuff, but then I realized that the imagery, sunny disposition of the spokeswoman, and overall subtle manipulation is probably far more powerful than the actual information content for many viewers.

Now it turns out that if you take the stuff, you're likely to experience symptoms of menopause when you stop anyway -- in other words, you're just delaying them. But Diana B. Petitti, M.D., writing in last week's JAMA, in a confusing essay which seems to be trying to support continued prescribing of Prempro while presenting nothing but very good reasons why nobody should come within forty feet of the stuff, notes that

[S]tudies have shown that women who are randomized to the placebo group of [sic] trials investigating a variety of treatments for menopausal symptoms often improve," and that "Accumulating evidence suggests many symptoms commonly attributed to estrogen deficiency [i.e., menopause] are not. . . [Of] symptoms commonly attributed to menopause, including . . .hot flashes and night sweats, vaginal dryness, sleep disturbances, mood symptoms . . . cognitive disturbances, . . . back pain, tiredness, stiff joints, urinary incontinence, and sexual dysfunction, [an NIH panel] concluded that the evidence established causality only for [hot flashes and night sweats], and vaginal dryness."

For many years, HRT was touted as a miracle cure for aging. It was supposed to keep skin youthful, protect against cognitive decline, keep women sexy and sexual -- and in fact, there are still various quacks promoting it for those purposes. It's pure crap.

As we grow older, we change. Some of the changes we like -- hopefully we get wiser and find more equanimity -- some of them we don't. Most people would like it if their bodies didn't start to wear out and run down, and I won't argue with that. But menopause, as such, it seems to me is just a part of life. It causes some transient annoying, but seldom disabling symptoms. Then you can't have babies any more, but on the other hand you no longer have the curse. That's it. There's no need for a magic pill. And Wyeth should stop selling the stuff. Now.


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