There’s big, positive health news: The FDA has removed the warning label on estrogen therapies for menopause.
That “black box” warning has discouraged a generation of physicians from prescribing estrogen to relieve menopausal symptoms such as hot flashes, brain fog, loss of libido, insomnia, and mood swings.
But wait—isn’t estrogen dangerous? Doesn’t estrogen cause breast cancer?
No.
Until 2002, the medical establishment considered estrogen a valuable tool in treating menopausal symptoms. But then a massive federal study of women’s health botched much of the science (sloppy subject selection, high attrition rate, ignored cultural factors), resulting in the premature shutting down of the study—with the explosive explanation that estrogen was too dangerous to continue it. That’s when the black box warning was added to this crucial medicine.
It has taken over two decades for organized medicine to recover from this disaster. Scare headlines always make page 1, and are memorable. Corrections are typically on page 6, easily overlooked, and rarely remembered.
After 2002, as prescriptions for estrogen plummeted, prescriptions for anti-depressants, anti-anxiolytics, and blood pressure medications rose—presumably to treat the menopausal symptoms no longer being alleviated with the newly-disfavored estrogen.
Enter our heroes, urologists Dr. Kelly Casperson and Dr. Rachel Rubin. Building on the work of Drs. Avrum Bluming, Carol Tavris, and James Simon, they pushed this issue for years. Last year Casperson and Rubin were appointed two of the twelve docs on the FDA panel that just unanimously approved the labelling change.
Today, more women live to and beyond menopause than ever in human history. 10,000 years ago, few women lived to menopause. Since then, science (vaccines, sanitation, safer childbirth) has increased our lifespan way faster than evolution normally would.
Science can help us deal with many of the resulting challenges of aging (with reading glasses, protein shakes, hip replacements, Viagra, etc.), making our lives more enjoyable. For most women, menopausal symptoms are another challenge that science can help ameliorate.
Two things now need to happen:
1) Doctors need to get the word.
Medical schools need to reverse course, implementing the current knowledge on estrogen for menopause. This includes understanding that estrogen can also protect middle-aged women from osteoporosis, dementia, and heart disease—by far this age group’s leading killer.
2) Women (and those who love them) need to get the word.
That means taking the symptoms of menopause seriously. And it means understanding that most women’s predictable struggles can be decreased or even prevented. And it means that women will have to educate their doctors. Yes, we all have to do that sometimes, and not just women.
Sixty Million Women
Today, some doctors are making sure that the small number of trans patients they treat have access to estrogenic hormones—while most doctors are still uninformed or hesitant about giving estrogen to the roughly 60 million American women living in menopause.
So most doctors need an updated education. And the FDA action should now lead to consideration of adjacent issues. These include the hormonal needs of perimenopausal women (typically aged 38-48), and the use of testosterone for women—for which Dr. Casperson has been crusading (see her new book, The Menopause Moment).
For now, let’s celebrate the sudden triumph of scientific good sense, and hope it turns into an epidemic.
