July 11, 2023
Good morning. In today’s either/view, we discuss whether hormone therapy is a safe treatment for menopause. We also look at the introduction of a mobile pet crematorium in Maharashtra, among other news.
📰 FEATURE STORY
Is hormone therapy a safe treatment for menopause?
Women’s healthcare has come a long way with new research, drugs, and treatments. However, history is a stark reminder that for all the strides that have been taken, there’s so much more to do, and the efforts so far seem insignificant. Women’s healthcare can often start and end with pregnancy.
There’s another issue that the medical community needs to talk about more – menopause. For many women, it’s not just a natural process of ageing. It can be a tough, painful, and drawn-out battle. For working women, it’s a reason they leave the workforce. Many have turned to Hormone Replacement Theory (HRT) as a cure. The medical community seems divided on how effective HRT can be in this case.
Context
A condition that affected half of the human population went without a name for a long time. Only in 1821 did the term menopause come into the lexicon, thanks to French doctor Charles-Pierre-Louis de Gardanne. While the concept itself wasn’t original to him, by the time he released his book, “Menopause, or the critical age of Women”, the idea he talked about had been at least a century old.
Doctors began writing about a medical condition that often dealt with the end of menstruation and the problems it may cause. They began to write about conditions affecting one gender at a critical time. In the early days, menopause was associated with a wide variety of symptoms, some of them severe.
In the early modern European medical space, some of the terms used were hysterical suffocation, melancholia, and chlorosis, otherwise known as green sickness, thought to affect adolescent girls. At the beginning of the 16th century, there was still no mention of menopause in European culture or anywhere with a written medical tradition. Some of the symptoms observed were fevers, cancers, ulceration of the skin, and epileptic seizures, among others.
In the 19th century, with more discoveries about the central nervous system and the brain, writings on menopause and behavioural symptoms became more synonymous and prominent. Edward Tilt, the author of The Change of Life in Health and Disease, the first book on menopause in English, wrote that alcoholism and mania were symptoms. He even suggested women could become violent.
In the early 20th century, endocrinology meant scientists could identify hormones. This was a turning point. Menopause was redefined as a hormonal problem. In the long run, it was seen as a deficiency of estrogen, the primary female sex hormone. Estrogen was believed to be important to health in all stages of a woman’s adult life, and post-reproductive women didn’t produce enough. In many ways, the idea that menopause is a deficiency of estrogen is still influential today.
The rhetoric around menopause was male-dominated, misogynistic, and not very forward-thinking during this time. Gynecologist Robert Wilson once stated all post-menopausal women were castrates. His influential 1966 best-seller Feminine Forever was later found to be backed by a pharmaceutical company wanting to market HRT. No wonder he described the effects of estrogen on post-menopausal women to what insulin was for diabetics.
Menopause has been historically treated with everything from acupuncture to opium. When HRT came along, it was seen and marketed as a way for women to preserve their youth, mental acuity, and sexual attractiveness. Companies promised that their estrogen-replacement pills would cure the symptoms. In 1942, Wyeth Pharmaceuticals introduced the estrogen pill Premarin. While it was associated with a risk of endometrial cancer, using it with another hormone, progestin, was deemed safe. In 1992, it became the best-selling drug in the USA.
In 2002, things began to change. A study of 17,000 post-menopausal women between the ages of 50 and 79 by the Women’s Health Initiative (WHI) showed a combination of estrogen and progestin was a risk to women’s health. More women were dying of heart disease, blood clots, and breast cancer on this regimen.
Since then, HRT has been under the scanner, but many continue to recommend it. In India, more women are turning to hormone therapy to manage their symptoms.
VIEW: Safe and effective
The WHI study led to confusion and fear among physicians and patients. HRT was considered deadly. Or so they thought. Years later, investigators realised the results were incorrect. While it was true that women over 60 on hormones had a higher risk of disease, it was partly because many women of that age already had that risk. A follow-up study of the WHI analysis 18 years later showed women aged 50 to 59 who took HRT had a lower mortality rate.
A paper published in the Canadian Medical Association Journal (CMAJ) recently stated that hormonal therapy should be offered to more women with severe menopause. It showed the risk of stroke in people under the age of 60 using hormone therapy was small. The review said menopausal hormone therapy was up to 90% effective in treating symptoms like hot flashes and improved mood disturbances and sleep.
The pervasive thinking around women’s health has often been “put up and shut up”. But doctors and even healthcare entrepreneurs want to change that. A pooled statistical analysis of thirty clinical trials showed women who began hormone therapy before 60 had a 39% lower risk of death. For many doctors, it’s an ordeal of unringing the alarm bell that was sounded in 2002. Medical startups are getting into the act to ensure women have the necessary information on menopause and hormone therapy.
COUNTERVIEW: Jury’s still out
As with any medical treatment, it’s about weighing the pros and cons and knowing the risks associated with a particular treatment path. While some have stated compounded hormones are fine, the thinking around that isn’t final. Compounded hormones aren’t approved by the US Food and Drug Administration (FDA). They’re not shown to be effective or safe and can have impurities.
There’s also the risk of dementia. Lisa Mosconi, director of the Women’s Brain Initiative and associate director of the Alzheimer’s Prevention Clinic, stated that decreased estrogen at menopause plays a role in women having a greater risk of Alzheimer’s than men. Hormone therapy doesn’t reduce this risk in all women. For women over 60 or more than five years past menopause, there’s some evidence HRT increases the risk of dementia. If women already have signs of dementia, hormone therapy could make things worse.
While HRT is seen as a common treatment, it should only be as a short-term solution and only when necessary. Since some studies have shown a link between breast and ovarian cancer and HRT, doctors should often look at alternatives if there’s a family history of those cancers. In 2017, the US Preventive Services Task Force recommended against HRT. Their conclusion was the risks outweighed any potential benefits.
Reference Links:
- The Secret Power of Menopause – The Atlantic
- A Brief History of Treating Menopause – AARP
- ‘She will not become dull and unattractive’: The charming history of menopause and HRT – The Guardian
- HRT used for menopause linked to dementia – but it may not be due to the treatment – Sky News
- Here’s The Current Thinking On Hormone Therapy (It’s Not What You Heard 20 Years Ago) – Forbes
- Hormone therapy should be offered to more women with severe menopause: review – CBC
- Hormone therapy for menopause linked to increased risk of dementia – Medical News Today
What is your opinion on this?
(Only subscribers can participate in polls)
a) Hormone therapy is a safe treatment option for menopause.
b) Hormone therapy is an unsafe treatment option for menopause.
🕵️ BEYOND ECHO CHAMBERS
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🇮🇳 STATE OF THE STATES
Flood warning (Delhi) – On July 9, the Shahdara district police inspected the Yamuna floodplains and alerted nearby residents to the Yamuna’s rising water levels. Prompted by heavy and incessant rains, the police asked them to evacuate and shift to safer areas. The Delhi government issued a flood warning in response to heavy rainfall curtaining most of North India.
Why it matters: Per the India Meteorological Department (IMD), the national capital received its highest rainfall in July on Sunday since 1982. Several parts of the city were substantially waterlogged, disrupting traffic and schedules. Netizens expressed concerns about the city’s drainage system. Meanwhile, the Delhi Traffic Police regularly updated citizens on mobility disruptions.
Kanti Velugu’s ophthalmologists (Telangana) – In June, the Kanti Velugu scheme celebrated a 100-day milestone. However, the celebration of the world’s largest eye screening programme was eclipsed by the government’s failure to pay salaries to ophthalmic officers and optometrists who participated in the scheme in large numbers. Paramedical Ophthalmic Officers (PMOOs) also await payment for their Auto Refractometer (AR) machines rented by the government.
Why it matters: 150 PMOOs who rented their AR machines to the government haven’t received a month’s payment since Kanti Velugu’s second phase began in January. The government had also promised a daily food allowance worth ₹250, which disappeared after the first 45 days. Optometrists were hired with an assurance of monthly remuneration of ₹30,000, which is still pending for May and June. The professionals complain of facing financial hardships.
Pride parade (Bihar) – The transgender community in Bihar will organise a Pride Parade in Patna on July 14 to demand a monthly pension for the community members, along the lines of the Jharkhand government’s recent announcement. Beginning from the Hindi Sahitya Sammelan in Kadamkuan, the parade will culminate at Premchand Rangshala to participate in a host of cultural events.
Why it matters: The organisers plan to discuss same-sex marriage and the surrogacy law. Social welfare minister Madan Sahni said the government has already taken steps for the transgender community’s welfare. The department will consider the demands in the letter before taking a position.
Mobile pet crematorium (Maharashtra) – Happy Buds Foundation, backed by Former Shiv Sena corporator Abhishekh Ghosalkar, has devised a way for Mumbai’s residents to bid a final goodbye to their pets in a dignified manner. It has set up an electric pyre inside a van so the cremation is environmentally friendly. It’s currently making the rounds in Dahisar and parts of Borivali.
Why it matters: The organisation will cremate stray animals for free, while pets will have a nominal charge. In Mumbai’s shrunken urban spaces, facilities to cremate animals are hard to come by. Ghosalkar believes the administration should note the response to the mobile facility, and initiate similar facilities in other wards.
Ghost schools (Assam) – After “ghost students”, the state government aims to find and remove ghost schools and teachers. Education Minister Ranoj Pegu announced that special grants to schools which failed to provide complete information about staff are halted, with salaries of such employees to be stopped in the next two months.
Why it matters: Ghost students, schools, and teachers are those entities that only exist on paper. It helps them obtain government funds for various motives. Pegu said over 11,000 lower and upper primary government schools haven’t complied with the department’s requirements regarding staff data.
🔢 KEY NUMBER
$57 billion – After a 6-8% compound annual growth in the last five years, the Indian pharmaceutical industry will hit approximately $57 billion by fiscal year 2025.