The history and controversy behind post-menopausal hormone therapy

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There is a widespread controversy regarding the risks and benefits of hormone therapy (HT) for post-menopausal women with no end in sight. Roughly 45 million women in the US are post-menopausal and HT has been the predominant form of treatment for most of the twentieth century.

But the history of these drugs (estrogen and estrogen plus progestin) illustrates a complex drama where different stakeholders with competing objectives can and did produce health practices and policies of questionable benefit.

A critical analysis publishing in the recent issue of the Journal of Social Issues examines the back-story and key stakeholders--including the women who the authors say, “emerge as both willing participants and unwilling victims of the unintended consequences of these drugs.”

Post-menopausal HT began as, and is still prescribed as, a treatment to the severe to moderate symptoms that arise around menopause. It became a potential long-term therapy for the prevention and treatment of the most common causes of morbidity and mortality of women, e.g. heart disease, osteoporosis, and dementia--uses that were not approved by the FDA. But controlled studies found that there was no benefit for women’s health-related quality of life, but there was increased risk in breast cancer, increase in cardiovascular events and stroke risk among other results leaving the stakeholders in a dilemma. “From a purely business point of view, the most reliable profits [for drug companies] can be made from disease processes and conditions that have high incidence and prevalence,” the authors state. Post-menopausal symptoms provide drug companies such an opportunity, even for those with drugs that create positive results, i.e. prevent heart disease. For physicians their professional credibility is affected and for women it’s personal. HT once held the promise of regained femininity and the prolongation of youth- now it holds controversy.

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This study is published in the current issue of Journal of Social Issues

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