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Opinion | Where the National Institutes of Health went wrong in menopausal research

(Ellen Weinstein for The Washington Post)
(Ellen Weinstein for The Washington Post)

Sharon Malone is a Certified National Menopause Practitioner and Chief Physician of Alloy Women’s Health. Jennifer Weiss-Wolf is a Women and Democracy Fellow at the Brennan Center for Justice at the New York University School of Law and author of “Public periods: To decide on menstrual balance. “

Twenty years ago, the National Institutes of Health abruptly completed research into the effects of hormone therapy on postmenopausal women. The decision resulted in a cascade of injuries to millions who have undergone menopause in the United States. And it remains uncorrected two decades later.

More than 1 billion people worldwide will be in menopause by 2025. Today, there are 55 million in the United States alone, of which nearly 75 percent report not receiving support or treatment for its effects. Among the most disabling are hot flashes, painful sex, urinary tract infections and the stressful combination of brain fog, anxiety, depression and insomnia.

It is a private burden that carries an expensive public toll. A 2021 survey of more than 5,000 women in the various stages of menopause revealed that three out of five were negatively impacted while on the job, and a third actively hid its effects on colleagues and bosses; almost half said they feared being stigmatized by raising it.

The safest and most effective treatment was swept off the table the moment the NIH announced a link between menopausal hormone therapy (MHT) and increased risk of breast cancer and certain cardiovascular diseases. The effect was immediate: Within several years, MHT prescriptions dropped from nearly 40 percent to about 5 percent among those who experienced menopause.

It would take more than a decade before government data were reassessed, and the net result showed that the risks initially reported did not apply equally to younger women or to those whose last menstrual period was within the last 10 years. And the positive effects of MHT – including a reduced risk of diabetes, colon cancer and osteoporotic fractures, as well as a 30 percent drop in deaths from all causes – never reached the public discussion. An entire generation subsequently missed out on not only improved quality of life, but also these preventive health benefits.

Today, the American College of Obstetricians and Gynecologists, the American Association of Clinical Endocrinologists, and the North American Menopause Society agree that MHT is a safe choice for the vast majority of healthy women with menopausal symptoms. Further research has shown that the link to breast cancer is minimal – statistically less than the risk of working as a flight attendant or drinking two glasses of wine for dinner every night – and in the case of those who use only estrogen, there is a decrease in risk .

However, we still lack definitive knowledge about whether cardiovascular disease or Alzheimer’s is affected by hormone therapy, despite subsequent studies suggesting that it is beneficial. And although recent studies strongly suggest that if treatment is started within 10 years after the last menstrual period or before the age of 60, the risk of hormone therapy is reduced, this information has not found its way into most clinical practices.

For anyone who has experienced menopause since 2002, the loss adds up to countless hours of productive work. Decades of satisfying and painless sex. The countless tons of bone mass leading to fracture and weakening. And the agency to determine for itself the quality of how we choose to age.

As a new generation enters menopause, we demand change. One of us (Dr. Malone) brought former First Lady Michelle Obama into the conversation. Tracee Ellis Ross got right about perimenopause in a recent profile in Harper’s Bazaar. And some companies are implementing menopause-friendly work policies.

But committed CEOs and influencers can only get us this far. The government must take the lead in necessary reforms.

It is imperative that the NIH redesigns and launches a new comprehensive reproductive health initiative that can inform us about the long-term benefits of hormone therapy and accurately assess its risks. Another immediate and solvable goal: to end the Food and Drug Administration’s “black box warning” on estrogen-only products, even the lowest dosage forms because they are obsolete and the risks attributed to them are greatly overestimated or not -existing.

Finally, the medical institution must give menopause the respect it deserves. While a third of American women are at some point in their menopause, most doctors do not even know how to talk about it, let alone treat it. According to the Mayo Clinic, only 20 percent of postgraduate residents reported that their programs had a formal menopause curriculum, and less than 1 in 10 residents in family medicine, internal medicine, and gynecology told the clinic they felt “adequately prepared” to handle care. of patients in the various stages of menopause. Add to that the well-documented bias towards female patients – one that exponentially burdens colored women, as well as trans, intersex and nonbinary people experiencing menopause – and a huge information vacuum continues.

When menopause is marginalized – and, worse, the search for therapies and solutions is set aside – the damage is far-reaching. We deserve better.

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