The dream is over: hormone replacement therapy, once hailed as a wonder drug, has finally been shown to be too risky to be prescribed for healthy women. Last week the Government's safety watchdog, the Committee on Safety of Medicines, warned older women without symptoms not to use HRT because of the risk of side effects; it also advised that the drug should no longer be used as the treatment of first choice for the bone disease osteoporosis, because the increased risk of breast cancer outweighs the potential benefits.
One committee member resigned, protesting that HRT is still the most effective treatment for osteoporosis, while the former Conservative MP Teresa Gorman boasted that she has taken HRT for 25 years and has the skeleton of a 15-year-old girl. This is not as impressive as it sounds, for osteoporosis affects only one woman in three and Gorman might well be among the fortunate majority. But HRT's dwindling band of enthusiasts cannot avoid several inconvenient conclusions, all of which have implications way beyond the debate about this particular drug.
One is that its benefits were wildly over-sold for years, with women led to believe it would protect them not just against heart disease and osteoporosis but the ageing process itself. The good news for women who want to stop taking HRT is that these anti-ageing effects are imaginary; the regulatory body in the United States, the Food and Drug Administration, has stated categorically that "studies have not shown that HRT prevents ageing and wrinkles". The myth that it does seems to have arisen because doctors who studied the first women to take HRT found that they lived longer, healthier lives. But, as a separate study confirmed last week, ageing is related to class and poor people show the signs much sooner. Early users of HRT were not typical and when use of the drug broadened to other social classes, the supposed anti-ageing effect disappeared.
What is inescapable is the conclusion that millions of women around the world have been taking part in a lengthy experiment, during which the assumed benefits of the drug have been gradually whittled away. It is reasonable to ask whether women have been responsibly treated by experts who assured them, without clinical evidence, that the drug would prevent heart disease and have other benefits. As the truth about HRT emerges, it is hardly surprising that people are vulnerable to other medical scare stories, such as the unproven thesis that there is a link between the MMR vaccine and autism. An erosion of trust may be one of the most damaging legacies of HRT, as women realise they have been advised to take a drug which was not fully tested before it came on the market.
One other conclusion emerges from this saga, which is the danger of allowing misogynist cultural assumptions to influence medical practice. The HRT fiasco came about because we live in a society that marginalises and denigrates older women, with the menopause seen as the crucial dividing line between youth and age. So pervasive is this process that since the 1960s, the menopause has come to be regarded as an illness that requires intervention from doctors, even for women who have no symptoms. The implication behind HRT - explicitly expressed in Feminine Forever, the influential book by the US gynaecologist Robert Wilson - is that every woman has a duty to stave off the ageing process for as long as possible.
Ironically, this assumption has become the norm at a time when women, supposedly the weaker sex, are living longer than ever. Most of us have more productive years ahead of us after the age of 50 than any previous generation, yet we also fret more about getting old. Taking HRT and self-mutilation - or "cosmetic surgery" as it is euphemistically called - are two of the measures women resort to as a consequence. But we now know that our anxiety about ageing has made us vulnerable to unsafe drugs whose true cost - thousands of extra cases of breast cancer, blood clots and heart disease - has been spelled out only in the last few months.
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- Breast Cancer
- Food And Drug Administration
- Heart Disease
- Life Expectancy