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Francine Hardaway: Estrogen Redux

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About ten years ago, estrogen was good for you. Every doctor prescribed it for any woman even close to menopause. Studies said it reduced the risk of heart disease and osteoporosis, in addition to making menopausal symptoms bearable.

And then came a NEW STUDY! Sales of Premarin dropped in half after the new study found that not only did estrogen not protect the heart–it actually raised the risk of heart attack. And didn’t do much for osteoporosis.

Millions of women bought fans, ate soy, and sweated. The jokes gave way to a new cultural consciousness of a natural process. It became okay to be in what used to be called euphemistically “the change.”

And then came still another NEW STUDY! In this week’s New England Journal of Medicine, this up-to-the-minute truth was intoned: Among women 50 to 59 years old at enrollment, the calcified-plaque burden in the coronary arteries after trial completion was lower in women assigned to estrogen than in those assigned to placebo. However, estrogen has complex biologic effects and may influence the risk of cardiovascular events and other outcomes through multiple pathways.

Throw away those fans, ladies. In the popular press, this was immediately translated as ”estrogen is good for you again.”

The release of information like this, which applies to a small number of women in a small age group, and concluded that estrogen may lower the incidence of calcified plaque, and calcification may be a risk factor for hear attacks, will shift the pendulum once again — now, as then, on the basis of incomplete information.

I think we need to do a better job of educating the media to reveal the complexity of issues like these, rather than oversimplify them and send women marching off one cliff and then another as they attempt to comply with ever-changing standards of care.

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