The end of HRT.
In July 2002, I spent day after day talking to reporters about the results of the Women's Health Initiative study of menopausal hormone therapy. As the director of the National Women's Health Network, I was called on to respond to the study's finding that taking hormones increased the risk of breast cancer and didn't prevent heart disease. The drugs being studied, Premarin and Prempro, are blockbusters bringing in over a billion dollars each year to their manufacturer, Wyeth. The news that the drugs used by so many women caused cancer was shocking to many, and the media treated this study as front-page news. I was asked over and over again what this meant for the millions of women currently taking hormones and what they should do. But like many feminists, I found myself trying to give answers to questions that weren't being asked. I wanted to talk about the medicalization of menopause and women's right to know the real truth about their bodies and about the drugs and medical procedures recommended to them.
I had only limited success in 2002. A few journalists made the connection between Wyeth's celebrity-studded advertising campaigns and women's mistaken belief that hormones prevented heart disease, Alzheimer's, wrinkles, and sexual decline. The occasional writer credited the National Women's Health Network or Dr. Susan Love with presciently warning that what doctors were telling women about hormone therapy wasn't necessarily the full truth.
But the bigger story wasn't really told, and I believe it's an important one. The assertions made by health feminists--that women have the right to know all relevant information about drugs, medical procedures, and bodily functions, and that menopause, childbirth, and puberty are natural conditions that don't always need medical management--relate directly to one of the key issues of the modern women's liberation movement: Who controls women's bodies?
Barbara Seaman tells the full story in her new book, The Greatest Experiment Ever Performed on Women. She explains, in vivid detail, the history of both menopausal hormone therapy and oral contraceptives. In both cases, she argues, there exists a mythology of estrogen, one that misleads, disempowers, and physically harms women. In the tradition of Gerda Lerner, whose The Creation of Patriarchy inspired feminists with the knowledge that patriarchy is not an unalterable facet of human nature, Seaman describes how the mythology of estrogen was created, so that women today can take it apart. In her words, she is "exploding the estrogen myth."
Seaman, now a columnist for Hadassah magazine, has covered this beat for 40 years and has interviewed most of the key figures and attended many of the key events. She begins by sharing a personal story. Seaman's Aunt Sally died of endometrial cancer shortly before her 50th birthday. The young doctor taking care of her aunt warned Seaman and Sally's other female relatives never to take Premarin. He was certain, he said, that Premarin caused Sally's cancer. "It's a special cancer. An estrogen cancer" he told Seaman. At the time, in 1959, Seaman was 23 and just starting out as a freelance writer on women's health and sexuality. She started a file on Premarin and cancel but for the time being could do little about the warning she'd received.
Meanwhile, many other women who hadn't received any warnings about estrogen causing cancer were being offered estrogen pills by their physicians. To women who turned to their doctors for help with disruptive hot flashes and night sweats, estrogen was effective medicine that they appreciated. But unbeknownst to these women, their doctors were being encouraged to think of estrogen as far more than just a treatment for hot flashes. Premarin was the most popular brand of estrogen from the start and remains so to this day. "The Premarin ads were charming ... Designed to foster fantasies of a fountain of youth, they featured women of a certain age having fun, being admired, sometimes waltzing with impeccably dressed handsome gentlemen who (you could tell) adored them." Doctors responded by steadily increasing the number of prescriptions they wrote for Premarin and other estrogen drugs.
But it took more than ads in medical journals to create a shared view of menopause as a medical problem that always needed treatment. Seaman explains that this shift was accomplished by marketing estrogen as a "replacement" for hormones lost as women aged and their menstrual cycles came to an end. Messages aimed directly at women started to percolate through popular culture in the 1960s, with Robert A. Wilson's book Feminine Forever the best-known example. Wilson claimed that menopause caused a precipitous decline in women's overall health, sexuality, and mental state, and that estrogen was the only cure. His argument, says Seaman, was that "A woman is not 'complete' unless she takes hormone replacement pills. She will be 'condemned to witness the death of her own womanhood.' She cannot be 'forever feminine' unless she takes hormone replacement therapy." Wilson's descriptions of menopausal women suffering from "living decay" and being in a "vapid, cow-like state" certainly offended some women, but many more absorbed the message that menopause must be treated.
In the 30 years following the publication of Feminine Forever, a series of medical benefits were claimed for menopausal hormone therapy. Women were told that estrogen prevented fractures, heart disease, and possibly even Alzheimer's--but they weren't told that studies hadn't definitively proven any of these claims. There were always some studies that doctors could cite to back up their claims that hormones helped menopausal women age more healthfully. At one point over a dozen studies seemed to show an association between using hormones and experiencing fewer heart attacks. But Seaman points out that the right kinds of studies, those that were able to sort out the influence of the hormones from the influence of the health-conscious lifestyle of the women using the hormones, weren't even begun until the 1990s, and even then only at the insistence of skeptical activists.
When the Women's Health Initiative results were announced, they completely undid the culturally accepted view of menopausal hormone therapy. The news media at the time focused on the fact that hormones didn't prevent heart disease or Alzheimer's and that they increased the risk of breast cancer and blood clots. What didn't get as much attention was the finding that the women in the study experienced none of the quality of life improvements that have been advertised for over 60 years. They didn't have more energy, better sex, of improved mood. So much for the happy, healthy older woman waltzing with her adoring partner!
In The Greatest Experiment, Seaman shows that what had been commonly "known"--that women need to replace the hormones lost through menopause to be healthy and enjoy life--wasn't knowledge at all, but spin. She acknowledges that some women do experience problems with menopause, and rightly credits early estrogen researchers with good intentions. But she uses this story, which she aptly describes as a decades-long experiment on women without their consent, to illustrate women's need to learn as much as possible about the drugs and medical procedures being recommended to them.
Woven throughout the history of menopausal hormone therapy, Seaman tells another estrogen-related story, that of the development and introduction of oral contraceptives. The FDA approved the first oral contraceptive in 1960. In the early 1960s, when Seaman was a writer for Dr. Joyce Brothers, the TV psychologist, she says, "We were swamped with questions and comments on Enovid, the first oral contraceptive." Over the next few years, as Seaman checked out the science, she became convinced that women were not receiving accurate information about the risks and side effects of birth control pills. As a result of her work, Senator Gaylord Nelson began hearings in January 1970 "to explore the question of whether users of birth control pills are being adequately informed concerning the pill's known health hazards." By that time, the early, high dose pills had been removed from Great Britain's Health Service formulary and replaced with safer, low dose pills, but they were still being marketed in the United States.
Nelson's plan for the hearings was to take the drug companies to task for their disregard of women's right to know and to publicize studies of the effects of the pill However, Alice Wolfson and other women from DC Women's Liberation changed all that.
Suddenly.... there was a disturbance from some women in the audience. Someone asked, "Why are there no patients testifying at these hearing?" ... When I turned to check out the disturbances, so did the rest of the people at the press table ... who quickly shifted their attention ... to the Wolfson women committing civil disobedience right there in the Senate, presenting their spontaneous testimony based not on scientific research but on their own life experiences. (pp. 131-132)
Direct action inside a Senate hearing room was unheard of in 1970 and immediately made news. The protests were reported on the nightly news and in major media around the world in the weeks following. Seaman describes the result:
So successfully did DC Women's Liberation make its case that Hearings on medical topics that excluded testimony from patients would soon become a thing of the past. But the Boston Tea Party of the women's health movement went far beyond establishing a patient's right to testify before Congress. It led to the opening up of consumer access to information on all prescription drugs, to patient participation on FDA committees, and it helped to determine how to move forward with NIH and other government clinical trials ... Ultimately, the group succeeded in shifting some power from entrenched interests to ordinary people. (p. 134)
At this point in the book Seaman is describing not only her beat as a journalist, but her own involvement in founding a movement of which both she and I are a part. The National Women's Health Network sprung from the work of Seaman, Alice Wolfson, and others, and continues in their spirit to this day. In The Greatest Experiment, Seaman recounts the stories of menopausal hormone therapy and oral contraceptives with the juicy details of an insider and the biting analysis of a feminist critic. By sharing these stories, Seaman tells us not only how women's health has been poorly served by the mythology of estrogen, but also how we can undo the harm done and create a better, healthier future for all women.
CYNTHIA PEARSON joined the women's health movement the night she saw cervical self-examination. Four years earlier, Carol Downer first shared cervical self-examination with members of a Los Angeles abortion rights group after being inspired by the transformative potential of direct action when she heard a radio account of Alice Wolfson's disruption of the Senate pill hearings. Pearson began working at the National Women's Health Network in 1987 and has been its executive director since 1996.