DON'T TREAT MENOPAUSE AS A DISEASE : COMMERCE, NOT GOOD MEDICINE, IS BEHIND RECOMMENDATIONS THAT WOMEN PAST 50 TAKE HORMONES FOR THE REST OF THEIR LIVES.

Byline: Susan Love

JUST as the baby boomers hit middle age, the pharmaceutical industry and the medical profession have discovered a new disease: menopause, or as it is called clinically, estrogen deficiency disease.

That this diagnosis automatically applies to the 40 million women turning 50 over the next decade doesn't seem to bother the medical powers that be, especially since they have a remedy at hand: artificial replacement hormones.

It is true that women who have had hysterectomies may want to take hormones until the natural age of menopause. Other women have troubling symptoms, like hot flashes and insomnia, as they approach menopause that warrant treatment with hormones. No one has argued that short-term use of hormones is dangerous.

The symptoms before menopause are transient, a kind of puberty in reverse. After three to five years, women can gradually taper off the treatment and suffer no more symptoms. But now the push is on to use these drugs on a long-term basis, in the name of disease ``prevention.'' From my position as a breast cancer surgeon, I worry that prolonged hormone treatment increases the risk of a woman developing breast cancer and other diseases.

Yet pharmaceutical companies have launched an expensive ``educational'' (read: advertising) campaign directed at both doctors and women. Premarin, an estrogen product made from the urine of pregnant horses, is already the biggest-selling drug in the United States. The American College of Obstetrics and Gynecology recommends that every postmenopausal woman should be on ``replacement'' hormones for the rest of her life unless she has a compelling medical reason not to be.

But this sweeping recommendation is based on inadequate scientific evidence. Menopause is not a disease; it is a normal part of life. A woman's ovaries don't shut down at menopause. They continue to produce low levels of hormones well into a woman's 80s. Synthetic hormones don't replace something that is missing when women reach menopause. They add something that is not naturally there.

Many gynecologists who favor long-term hormone therapy argue that as the average life expectancy has expanded, these drugs are necessary to maintain our health. Wrong. Women have long lived well beyond menopause into old age. Our ovaries are genetically programmed to shift gears.

Pharmaceutical companies have realized that in marketing their products to women it is smarter to emphasize diseases rather than the hormone treatment. Some advertisements warn women about conditions like osteoporosis, which occur in postmenopausal women.

In this effort, the companies are helped by the medical profession, which in recent years has redefined osteoporosis. The disease used to refer only to actual fractures caused by the thin bones of old women. Now osteoporosis is defined as low bone density. This is like telling someone with high cholesterol that he or she has heart disease.

Women are also encouraged to have bone-density tests just as they are encouraged to have mammograms or Pap smears. The result is an epidemic of healthy 50-year-old women being ``diagnosed'' with osteoporosis - even though women on average don't have hip fractures until they turn 79. (Someone once said that if you are healthy, you haven't had enough tests done yet.)

There is some question whether a woman has to take hormones starting at age 50 to prevent these fractures. In a recent study by the prestigious Journal of the American Medical Association, women who took hormones after the age of 50 had a better bone density at age 70 than women who had not taken the drugs or who had stopped taking them.

But the research also indicated that women who started taking hormones in their mid- to late 60s had almost the same bone density in their mid-70s as those who had taken them for 25 years.

The studies on osteoporosis are confusing; the data on heart disease are inconclusive. The most often quoted studies that claim estrogen prevents heart disease are based on studies observing women who are on hormones for whatever reason compared with women who are not on hormones.

True, the women on hormones have 50 percent less heart disease - but they are also better educated, richer and more likely to see a doctor and take care of their health than the women not on hormones. Until a study takes these factors into account, we won't know whether hormones make you healthy, or whether healthy women take hormones.

There is one thing we do know: Taking hormones for more than 10 years could increase a woman's risk of developing breast cancer. The Nurse's Health Study, a definitive 14-year study of 122,000 nurses issued in 1995, estimated that women between ages 60 and 64 who took hormones for at least five years increased their risk of getting breast cancer by 71 percent. They increased their risk of dying of breast cancer by 45 percent.

Yet pharmaceutical companies defend their products by pointing out that one in three women dies of heart disease, while one in eight women gets breast cancer. Although this is true, it is important to note that in women younger than age 75 there are actually three times as many deaths from breast cancer as there are from heart disease.

If you take smokers out of the mix (smokers are more likely to develop early heart disease than nonsmokers), there are six times as many deaths from breast cancer as from heart disease for women under 75.

And several studies have concluded that hormones also increase the risk that women will develop blood clots and gall bladder disease. Uterine cancer is 14 times higher in women on estrogen alone and four times higher in women on both estrogen and progestins.

Estrogen therapy may prevent diseases, yet it could cause others. Are there women who could benefit from taking hormones for prevention? Probably. But should all postmenopausal women be on them? Certainly not.

Graham Colditz, one of the authors of the Nurse's Health study, estimates that 90 percent of heart disease cases could be eliminated if people changed their lifestyle; this means encouraging women to exercise, watch their diet and quit smoking. But no one would get rich. And hormone therapy is, after all, about money, isn't it?

Merck and Wyeth Ayerst have announced a joint venture to develop ``disease management'' programs for women. I can imagine what these programs will suggest to postmenopausal women.

Women must redefine menopause as something natural. We need to make sure that we have accurate information and not wishful thinking. And we must be on our guard lest vested interests sell us a bill of goods.