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Tropic of Cancer 
The news on breast-cancer research that could save lives
2/18/2002 |
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Estrogen
It may be an elixir of youth, but is there a risk of cancer?
6/26/1995 |
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The phones haven't stopped ringing since. Women across the U.S. immediately started calling their doctors, their mothers, their daughters, their friends. Are you still taking your pills? Do you think plant-based hormones are any better? Would lowering the dosage make it any safer?
"Maybe I've been too trusting. I still don't feel like I have all the facts and details," says Jodi Simma, 55, a homemaker who engaged nine friends in a spirited discussion over salads and lemon dessert in New Richmond, Wis., last week.
"We're all concerned," says Muriel Smith, membership coordinator at the Dave and Mary Alper Jewish Community Center, south of Miami, which is organizing a panel discussion on the topic. "Everyone wants to know what to do."
Some, like Ellen Robinson, 58, a commercial litigator who works in Chicago, have already made up their minds. Robinson decided last week to stop taking her hormones cold turkey. "I haven't had breast cancer, a stroke or a heart attack," she explains, "but now I'm nervous. Everyone has been in the dark about the risks."
Others who were skeptical of hormones all along feel vindicated. "I'm not antiestrogen, but we need to accept menopause as a natural, normal, physiological process," insists Vicki Meyer, founder of a cybercommunity called the International Organization to Reclaim Menopause. The idea that our bodies fail us at menopause, she says, is "ludicrous, extremely sexist and just plain wrong."
Physicians are scrambling to keep up. A gynecologist in Dallas has written a script to help her office staff deal with the deluge of calls. The American College of Obstetrics and Gynecology has created a task force to rethink its guidelines on HRT. "The bubble has burst," says Dr. Isaac Schiff of the Massachusetts General Hospital in Boston, who is chairing the task force. Schiff admits that in the aftermath of last week's news, doctors need as much guidance as their patients. "Some physicians say they are not going to change things in their practice at all and will be as proactive for HRT as they've ever been," he says. "Others say this will change their thinking dramatically."
The Estrogen Express
To understand how we got to this point, it helps to know a little medical history. About 40 years ago, attention was focused on just one female hormone, estrogen. Its greatest popularizer was a gynecologist named Robert Wilson, who thought the hormone could serve as an all-purpose rejuvenator for women of a certain age. There was, it must be admitted, more than a little sexism, not to mention ageism, in his point of view. In his hugely successful book, Feminine Forever, published in 1966, Wilson wrote of menopause as a "living decay" in which women descended into a "vapid cow-like" state. Supplemental estrogen, Wilson insisted, would almost magically transform the dull cow into a supple, younger-looking wife and mother. She would not only feel better but also make those around her feel better—especially, it was implied, her partner in bed.
Those were different times, of course. But the idea that a single pill might turn back the clock quickly caught the popular imagination. It didn't hurt that the hormone's No. 1 manufacturer, Wyeth Pharmaceuticals, launched an aggressive marketing campaign. Thank goodness today's spots have been updated to feature the dulcet tones of singer Patti LaBelle and have abandoned patronizing messages like the one in a 1975 ad—"Almost any tranquilizer might calm her down ... but at her age, estrogen may be what she really needs."
Over the years the medical arguments for prescribing estrogen were also updated. "The vapid cowlike state was gone, and there was very scientific language about bone density and heart disease," explains Cynthia Pearson, executive director of the National Women's Health Network, a longtime skeptic of HRT.
It all seemed so logical and convincing. Women are much less likely than men to suffer heart attacks and strokes in their 30s and 40s. But when natural estrogens stop flowing after menopause, women's risk quickly catches up to men's. Clearly estrogen has some kind of positive influence. And sure enough, a number of studies in the 1980s showed that women who took the hormone at menopause had lower levels of LDL cholesterol, the so-called bad cholesterol, and higher levels of HDL, the so-called good cholesterol, than those who didn't. The benefits of supplemental estrogen couldn't be more obvious.
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