Welcome to the latest culture war: those who can and those who can’t say no to taking estrogen and progesterone._
“When I started telling my friends I’d gone on the estrogen patch, I might as well have announced I’d taken up smoking two packs a day,” says 54-year-old Nancy Wurtzel of Thousand Oaks, California, who was suffering from hot flashes, irritability and sleeplessness. “They were horrified. One friend said, ‘Why don’t you just exercise more?’ ” Wurtzel recalls, her voice rising with anger. “I said, ‘I AM exercising! I’m doing everything, and it’s not helping!’ ”
Gynecologist Risa Kagan, MD, who teaches at the University of California, San Francisco, has heard plenty of stories like Wurzel’s. “One patient told me she’s in two book clubs. In one, a couple of the women are on estrogen, and she could be honest and tell the club members that low- dose estrogen has really helped her with the worst of her menopause symptoms. But in her other book group, her friends lecture her, yell at her, and make her feel horrible for taking hormones. She kept her ‘drug habit’ in the closet for a long time. I think she wishes it was still there." Kagan adds: "This is the world women are living in now.”
After going on the estrogen patch and progesterone IUD myself for hot flashes, sleeplessness and anxiety, and feeling the harsh disapproval of some pals, I decided to scour the country through friends, gynecologists, nurses, general practitioners, and bulletin boards of both the electronic and non- electronic variety, to see how common my experience was. Before long my inbox and answering machine were flooded with messages from women happy to share their stories of enduring criticism from friends and doctors, although they weren’t always eager to share their names.
The News That Changed Everything
The 2002 Women’s Health Initiative (WHI) study caused two-thirds of women taking the drug to come off it, largely out fear of breast cancer, and to a lesser extent, strokes and blood clots. Now, only 10 to 13 percent of peri- and menopause-age women choose to do hormone replacement, down from a high of 40 percent before 2002. However, more careful analysis of the data from that trial, as well as newer research, indicates that HT may in fact pose less risks than many in the U.S. believe. The data suggest that hormone therapy may be fairly safe for women with severe symptoms if started close to menopause, and may even be beneficial for women who don’t have risk factors that could predispose them toward breast cancer, strokes or blood clots.
While only a handful of doctors advocate staying on the drugs indefinitely, many now believe that studies in the works will add to the evidence that hormones taken before 60 can lower the risk of coronary heart disease, reduce the onset of diabetes mellitus, and prevent menopause-related bone loss. The North American Menopause Society, for one, estimates that HT may reduce total mortality by 30 percent when used by women younger than 60. (For more on risks, see “Just How Safe is HT?”)
