The HRT crisis offers a chance for change
A large-scale American study of women on hormone replacement therapy (HRT) was abruptly halted at the start of the month after it became clear that the drugs used caused "a slight but significant" increase in the risk of breast cancer. Seventeen percent of menopausal women in Israel take estrogen and progestin replacements.
A large-scale American study of women on hormone replacement therapy (HRT) was abruptly halted at the start of the month after it became clear that the drugs used caused "a slight but significant" increase in the risk of breast cancer.
Pandemonium immediately erupted when the news broke. Anat Maor, MK (Meretz) urgently convened the Knesset Science Committee, and telephones in gynecology clinics were ringing off the hook as worried women asked their doctors what they should do. What should they take, or not take, now?
Seventeen percent of menopausal women in Israel take estrogen and progestin replacements. Most are now asking pointed questions of the sort that perhaps they should have asked themselves, and their doctors, years ago. They are getting varied, and sometimes contradictory, replies. One need only browse through the web sites and the books dealing with menopause and hormone replacements to become convinced that every answer breeds another question.
For instance, Professor Henri Rozenbaum, head of the French Association for the Study of Menopause, claims in his book "La Menopause: Questions de Femmes" that a certain rise in the incidence of breast cancer among women who take hormone replacements is actually a good sign.
It is because women who take these replacements are under close medical supervision, and therefore the disease is discovered early. But the question remains - was it the estrogen that caused the cancer?
The hormone panic reflects something much deeper than the desire to eliminate the sleep disorders and hot flashes associated with menopause. Throughout history, dramatic social and cultural changes have come through women - witches, saints, women who learned more than they were permitted to, women who led princes to war.
The joint effort by women and doctors to fight menopause and its uncomfortable symptoms, and thereby also to postpone aging as far as possible, is only the tip of the iceberg of a feverish effort that goes to the heart of the western world - an effort not only to improve quality of life at every age, but also to make youth last forever.
On the backs of two groups, several giant pharmaceutical companies, with annual turnovers of billions of dollars and profit margins of 19 percent, are cleaning up. These are the women who mourn wrinkled skin and lost fertility, and who suffer the betrayal of the body and the isolation and rejection of a society that worships 14-year-old models. And there are also are the doctors, who know less every day in the face of thousands of new studies and thousands of social changes.
Why be surprised? Undoubtably, it will soon emerge that the person who stopped the study and publicized that fact has a serious financial interest in the hormone replacement market. Veteran doctors remember how the "trend" of hormone replacements got started at the end of the 1970s - when an American company whose sales had dropped to $400 million a year began an information campaign about osteoporosis.
That was sufficient to later promote the appropriate hormone replacements. "We were carried away," says Dr. Menachem Fisher, chairman of the Community Gynecology Association and deputy chairman of the Gynecological Association. "But how could it have been otherwise?"
Fisher is one of the leading advocates of a new medical approach, which calls for establishing a partnership between doctor and patient on the basis of human rights and social solidarity. He says this idea has been snowballing and is now reaching doctors as a consumer demand.
"Every time a new technology appears, or it becomes known that in New Zealand, for instance, they have discovered a new medicine, and they tell us that heart disease is the number one cause of death, and that the new medication also helps prevent that, and as an added benefit, it is also good for facial skin - I, as a doctor, am overjoyed that I have something to give."
"Something to give" is a key phrase for both doctors and patients - especially when you are talking about a frightened woman and a perplexed, or prejudiced, or egotistic doctor, or one who is an enthusiastic agent, whether wittingly or not, for a pharmaceutical company.
And when the drug also promises smooth skin and marvelous sexuality, who would refuse it? "Now," says Fischer, "the controlled studies have begun, and enthusiasm has been replaced by disappointment." And when the gods disappoint, the anger directed at them is terrible. Thus, Fischer proposes setting up an open committee that will gather all the available research, convene in a kind of medical Camp David and publish the most up-to-date findings.
And beyond the field of medicine, it is also possible to think a little about what the hormone crisis offers western society - an opportunity to uncouple the real need to treat the symptoms of menopause from the pursuit of eternal youth. There is, perhaps, also an opportunity to restore to age something of its lost dignity.