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The Estrogen Elixir

A History of Hormone Replacement Therapy in America

Elizabeth Siegel Watkins

Publication Year: 2007

In the first complete history of hormone replacement therapy (HRT), Elizabeth Siegel Watkins illuminates the complex and changing relationship between the medical treatment of menopause and cultural conceptions of aging. Describing the development, spread, and shifting role of HRT in America from the early twentieth century to the present, Watkins explores how the interplay between science and society shaped the dissemination and reception of HRT and how the medicalization—and subsequent efforts toward the demedicalization—of menopause and aging affected the role of estrogen as a medical therapy. Telling the story from multiple perspectives—physicians, pharmaceutical manufacturers, government regulators, feminist health activists, and the media, as well as women as patients and consumers—she reveals the striking parallels between estrogen’s history as a medical therapy and broad shifts in the role of medicine in an aging society. Today, information about HRT is almost always accompanied by a laundry list of health risks. While physicians and pharmaceutical companies have striven to develop the safest possible treatment for the symptoms of menopause and aging, many specialists question whether HRT should be prescribed at all. Drawing from a wide range of scholarly research, archival records, and interviews, The Estrogen Elixir provides valuable historical context for one of the most pressing debates in contemporary medicine. Praise for Watkins' On the Pill: "An exemplary study of how the nation which first had access to oral contraceptives first came to terms with their advantages, and their drawbacks."—Times Literary Supplement "Intelligent and well-structured . . . An admirable exercise in social history."—Nature "A particularly fascinating issue, trim and focused, sophisticated and helpful, fresh and very interesting."—American Historical Review "In every carefully organized, lucidly written chapter Watkins provides surprising corrections to conventional thinking about the new birth control method."—Journal of American History "Anyone concerned with the debate over scientific advance and medical authority will find this a highly stimulating study."—Journal of American Studies

Published by: The Johns Hopkins University Press

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Acknowledgments

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pp. vii-x

The list of institutions and individuals to whom I owe thanks is long. First, I wish to acknowledge the following sources of funding: the National Endowment for the Humanities for a summer stipend in 1999, the American College of Obstetricians and Gynecologists for an ...

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Introduction

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pp. 1-9

Every woman who lives to a certain age reaches menopause. Decreased estrogen production in the years during and after menopause has been blamed for causing everything from hot flashes to heart disease to diminished femininity. One possible remedy has been to replace that lost estrogen with hormones from outside the body. The scientific and commercial development of pharmaceutical estrogen in ...

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1. Beginnings

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pp. 10-31

In 1919, upon their discharge from the United States Army after service in World War I, two young men found themselves in St. Louis. One was a gregarious, heavy-set biologist trained at Brown University; the other was a reserved, slim biochemist trained at Harvard.1 Both had accepted positions at Washington University School of Medicine. Both were newly wed. Both liked to play baseball ...

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2. From the ‘‘Neutral Gender’’ to ‘‘Feminine Forever’’

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pp. 32-51

Twenty-five years after Doisy and Allen arrived in St. Louis, another young man landed in the city to begin his scientific career. A recent medical graduate from the University of Rochester, this 28-year-old doctor moved to Missouri for an internship and residency in obstetrics and gynecology at St. Louis Maternity Hospital and Barnes Hospital of the Washington University School of Medicine. ...

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3. Selling Estrogen to Doctors

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pp. 52-68

Photograph number one: An attractive woman is seated on a lawn chair in a suburban backyard on a sunny afternoon. She has nicely coiffed gray hair; her face is unlined. Her husband, also gray-haired and good-looking, is sitting next to her. They are both smiling, perhaps in response to something a little girl in the foreground is saying or doing. Another little girl runs toward the couple. A ...

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4. Selling Estrogen to Women

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pp. 69-92

The man who brought hormone replacement therapy to the attention of the American public traced his professional interest in menopause to two key events in his boyhood in Ramsbottom, an industrial town in Lancashire, England, in the early twentieth century. First, he remembered his mother’s ‘‘tragic decline’’ during menopause from ‘‘that vital, wonderful woman who had been the dynamic ...

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5. From Hero to Villain: Estrogen and Endometrial Cancer

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pp. 93-108

Estrogen turned from hero to villain upon the publication of two studies that presented conclusive evidence that estrogen users were more likely to get endometrial cancer (cancer of the uterine lining) as compared to nonusers. The appearance of these two reports in the prestigious New England Journal of Medicine ensured that they would be taken seriously by the medical profession. The editors ...

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6. Enter the Feminists: Informing Women about Estrogen

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pp. 109-131

Viewers who tuned in to the NBC Nightly News on Thursday, 4 December 1975, learned about the latest witnesses to be subpoenaed in the ongoing case of the kidnapping and murder of Jimmy Hoffa, reported missing four months earlier. Stories followed on a tax bill in the House of Representatives, a Senate Intelligence Committee report on CIA involvement in Chile, the retirement of ...

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7. Enter the FDA: A Patient Package Insert for Estrogen

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pp. 132-147

The disclosure of the estrogen-endometrial cancer link coincided with a general loss of confidence in medicine in the 1970s, as doctors and hospitals faced challenges to their political influence, economic power, and cultural authority from the women’s movement, the consumers’ movement, and the patients’ rights movement.1 In 1966, the Harris Survey found that 73 percent of Ameri- ...

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8. Resurrecting Estrogen, I: Osteoporosis and Medical Science

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pp. 148-166

In 1980 American pharmacists filled about fourteen million prescriptions for estrogen, just half the number dispensed in 1975, when the Premarin brand alone had been the second most frequently prescribed drug in the country.1 By 1980 Premarin had dropped to number eighteen on the list of America’s top prescription medications.2 Then, after five years of steep decline, the annual ...

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9. Resurrecting Estrogen, II: Osteoporosis and American Culture

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pp. 167-186

Estrogen found its way back into women’s medicine cabinets via their bones, or, rather, via the fear that their bones were in danger of crumbling. The campaign to increase public awareness of osteoporosis popularized the benefits of exercise, calcium, and estrogen in maintaining bone density. Although the sale of gym memberships and fitness clothing may have increased, the two industries that ...

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10. Skeptics and Believers: Varieties of Women’s Responses

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pp. 187-204

As early as 1979 the Boston Women’s Health Book Collective had plans to incorporate information on aging into subsequent editions of Our Bodies, Ourselves. The members acknowledged that, as young and middle-aged women, they had no firsthand knowledge of what it meant and felt like to grow old, but they were seeking input from women with that direct experience.1 Initially, the Collec- ...

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11. Weighing the Benefits and Risks of HRT: Estrogen, Heart Disease, and Breast Cancer

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pp. 205-221

On a summer morning in 1991, three dozen people gathered in the Parklawn Building on the campus of the Food and Drug Administration in Rockville, Maryland, for a two-day workshop on the current status of combined hormone replacement therapy. This meeting was part of the regular quarterly schedule of the FDA’s standing advisory committee on fertility and maternal health drugs. What ...

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12. 1992: The Year of the Menopause

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pp. 222-239

Nineteen ninety-two, according to the pundits, was the year of the woman in politics. Eleven women won primary contests as candidates for the United States Senate, four of whom prevailed in November’s general election (Carol Moseley Braun of Illinois, Barbara Boxer of California, Diane Feinstein of California, and Patty Murray of Washington), bringing the total number of female senators to six ...

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13. Meno-Boomers: Another Generation Confronts Estrogen

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pp. 240-263

The 1990s were boom years for estrogen. In 1992 the American College of Physicians (ACP) recommended that ‘‘all women, regardless of race, should consider preventive hormone therapy,’’ as part of its ‘‘guidelines for counseling asymptomatic postmenopausal women about using hormone therapy to prevent disease and to prolong life.’’1 In 1994, the American Family Physician published a...

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14. The ‘‘Gold Standard’’: Estrogen and the Randomized Controlled Trials

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pp. 264-286

Estrogen underwent yet another reversal of fortune in July 2002. That month, the Women’s Health Initiative—the multiyear, multisite, multimillion-dollar, federally funded clinical trial of hormone replacement therapy—was stopped three years before its scheduled endpoint, because the study’s Data and Safety Monitoring Board concluded that the risks of adverse effects outweighed the benefits of ...

Notes

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pp. 287-340

Index

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pp. 341-351


E-ISBN-13: 9780801892257
E-ISBN-10: 0801892252
Print-ISBN-13: 9780801894862
Print-ISBN-10: 0801894867

Page Count: 368
Publication Year: 2007