THE DREAM OF AN elixir of eternal youth dies hard. In the past decade or so, millions of middle-aged women have come to believe that pills containing estrogen, the female sex hormone, can help them overcome the adverse effects of menopause. Now they are learning that it isn't necessarily so - and that overuse of estrogen can actually be dangerous. Starting this fall, that message is going to be circulated much more widely, because the Food and Drug Administration has just ordered physicians and pharmacists to hand out a special warning brochure with every prescription for estrogen drugs.
The FDA should be applauded for requiring such brochures, or package inserts, because estrogen can be a very seductive drug. Its manufacturers have fostered, and physicians too often reinforce, the impression that his pill cannot only cure menopausal nervousness and depression, but can also make post-menopausal women feel more energetic and feminine.
However, the FDA's warning states, "there is no evidence that this is so." There is hard scientific evidence that, while estrogen has certain medical benefits, long-term users are five to 10 times more likely to get cancer of the uterus, and may incur other health problems, too.
FDA therefore advises women to take estrogen only when really needed, and then to take the lowest possible dose. Such advice is usually dispensed by physicians, but FDA has rightly concluded that the normal process of doctor-patient communication needs to be supplemented by direct warning to consumers in this case. That is true in part because this particular drug has been so enthusiastically promoted and so liberally prescribed. Moreover, there is a growing awareness of the possible hazards of hormone drugs; the FDA already requires package inserts with oral contraceptives and has proposed similar treatment for progestins. These cases are now regarded as exceptions, but we hope that they will become precedents. Individuals should be offered more facts about the risks and benefits of many drugs and medical procedures, so they can make more informed decisions about their own health.