The Marketing of Menopause
Historically, Hormone Therapy Heavy on Promotion, Light on Science

audio icon Listen to Joe Neel's report.

Popularizing Estrogen

One of the first books to come out in favor of the use of estrogen treatment for menopause was Robert Wilson's 1966 work Feminine Forever. The book shocked the world by calling menopausal women "castrates". Two excerpts from the book:

"From a purely biologic point of view, estrogen therapy can hardly be regarded as altering the natural state of life. On the contrary, as we have pointed out before, it merely restores a natural harmony between the rate of aging and life expectancy, a harmony that has been disturbed by the lengthened lifespan of modern women. It is the case of the untreated woman -- the prematurely aging castrate -- that is unnatural."

Feminine Forever, by Robert A. Wilson, M.D.

"The myth that estrogen is a causative factor in cancer has been proven to be entirely false. On the contrary, indications are that estrogen acts as a cancer preventive."

Feminine Forever, by Robert A. Wilson, M.D.

Aug. 8, 2002 -- The stunning news that hormone replacement therapy may do harm has raised questions about the marketing of menopause. Since the first estrogen pill, Premarin, was introduced in 1942, makers of sex hormones have created a marketing and cultural phenomenon. As NPR's Joe Neel reports for All Things Considered, claims made for hormones through the years have been backed by only a modicum of scientific evidence, despite a flood of promotional books and films.

Early films made by drugmakers to educate doctors about hormone treatments are a blend of homespun medical wisdom and paternalism, playing on older women's fears. As in this excerpt from a 1972 film by the drugmaker Ayerst, the films are one part pseudoscience, one part hope for a second lease on life:

"The physical alterations that are associated with the menopause may induce emotional changes. When a woman develops hot flashes, sweats, wrinkles on her face, she is quite concerned that she is losing her youth -- that she may indeed be losing her husband."

A woman in a nightgown, sitting in a plaid easy chair in front of a fireplace says, "My boys are both gone and my husband is away a great deal with his work. The evenings bother me most. And I think we all give thought to the fact that our husbands might become interested in a younger woman, but I don't dwell on on the subject."

The film, titled Physiologic and Emotional Basis of Menopause, then asserts that diminished estrogen production during menopause may be related to various types of depression.

"Depression. It fit in nicely into the theories of the day, but there never has been any hard proof that estrogen works for depression," says reporter Joe Neel. "Or that it improves other emotional changes some women have. Or that it cures wrinkles."

Neel points out that what the promotional films show, in retrospect, is that estrogen "has always been a pill in search of an ill."

Estrogen's heyday started with a book for the masses, titled Feminine Forever. Author Robert Wilson was a Manhattan gynecologist with strong financial ties to hormone makers. The book shocked the world by calling menopausal women "castrates" if they didn't take hormones. He won women over with scientific-sounding promises of youth and beauty and good sex, even though the FDA banned Wilson from certain research for making unsubstantiated claims.

After the book, millions of postmenopausal women were taking the "Youth Pill" for all of life's ills. Other books and magazine articles followed, pushing estrogen as a salvation for older women and suggesting that estrogen might prevent cancer.

"Much of the information and misinformation persists to this day," says Neel.

But as the scientific picture filled in, it began to peel away the marketing mystique. In 1975, the New England Journal of Medicine published two studies documenting a strong association between cancer of the lining of the uterus and estrogen therapy. In 1989, the New England Journal of Medicine presented evidence linking estrogen to breast cancer.

And most recently, in July 2002, federal officials announced they had halted a Women's Health Initiative trial on hormone therapy. It showed that women taking a combination of estrogen and progestin hormones, marketed as Prempro, have an increased risk for breast cancer, heart disease and stroke. Another study published in July said women taking estrogen-only pills are at greater risk for ovarian cancer.

Despite the scientific warnings, women have continued to say yes to hormone therapy, and decades of marketing to women and physicians by hormone pill-makers is likely influencing that decision. But the studies released last month have led many women to change their minds -- at least for now. "If the history of menopause marketing is any guide, it won't be long until drug companies once again figure out a way to put hormone therapy back at the top of the charts," Neel concludes.

In Depth

audio icon NPR's Joe Palca reports on the Women's Health Initiative study on estrogen-progestin pills.

audio icon NPR's Patricia Neighmond reports on study by the National Cancer of Institute that says women taking estrogen-only pills are at greater risk for ovarian cancer.

browse for more NPR coverage More NPR stories on hormone therapy.

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