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Crazy ladies

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Many years ago, I read an article in Esquire by Nora Ephron entitled “Dealing with the, uh, Problem,” about the early days of the feminine-hygiene spray business. Ephron was investigating how Alberto-Culver managed to convince women, as a rival company had done in its advertising, that her “trickiest deodorant problem isn’t under her pretty little arms.” 

What interested me the most about the piece was marketing strategy: create the demand for the problem to sell the solution. And back in the 1970s, promoting their invented solution as feminist, part of the then-sexual revolution.

Tell women they are smelly and unattractive—that they’ve got an, uh, ‘problem’ so unmentionable that you have to sell it with euphemisms—and you can make a killing.

And Alberto-Culver (and many other companies following them) did just that: $40 million way back in 1973, which equates to $259 million today, on their market share alone. Today, the global market in feminine hygiene sprays is projected to grow to $54.52 billion in 2028.  

This has long been a ploy of the pharmaceutical industry. The drug industry sold the world on the idea that depression resulted from too little serotonin and heart attacks from too much cholesterol floating around in the body, clogging up arteries, blowing up hearts. 

Both situations were complete falsehoods, an invented cause of a problem, with a solution to be concocted in the laboratory. And immediately, the drug companies set about deftly seeding both ideas into the public consciousness and got rich in the process, with their hot-out-of-the-laboratory new drugs: selective serotonin reuptake inhibitors (SSRIs) and statins.  

I was reminded of all this the other day reading a headline in the Daily Telegraph: “Menopause ‘reshapes the brain,’ researchers find, and HRT should be prescribed earlier.”This was followed by a subtitle that read: “Academics say hormone replacement therapy should be seen as a ‘protective’ measure for perimenopausal women to halt ‘rewiring’ of the brain.”

This story has breathlessly arrived in the wake of the UK making hormone replacement therapy an over-the-counter drug, and journalists proclaiming it a feminist right.  

What followed was a huge run on the drugs to the point where drugstores have now run out of stocks, and the UK government was forced to begin emergency rationing and set up a special HRT Task Force to staunch the flow of HRT through the black market.

The Daily Telegraph  story concerned a year-old study claiming that a sharp decline in estrogen, as occurs during menopause, has a significant impact on the brain, reducing gray matter and changing blood flow.

As Dr Roberta Diaz Briton, a neuroscientist at the University of Arizona, stated in a forthcoming UK documentary, “Menopause is like a renovation project on the brain, a restructuring, a rewiring . . . the idea that we can just suck it up is actually deleterious to women’s long-term health.”

Dr Briton says that delaying treatment for a year after periods cease, the standard practice by general practitioners in the UK, could be dangerous because the “brain has already changed and it’s no longer going to respond to estrogen therapy.” 

Written almost as an afterthought in the Telegraph article is the study’s conclusion: some of those changes to the brain resolved after menopause—as did cognitive performance, “suggesting adaptive compensatory processes.”1 Those women who went on to get Alzheimer’s were only the ones genetically predisposed to it.

They also failed to mention an earlier four-year randomized study of menopausal women showing that increasing ventricular volume with HRT not only did not affect cognitive function but might be dangerous.2 

Or the WHIMS-MRI studies showing that once women stopped taking HRT, their rate of decline in brain volume remained similar to the placebo group.3 

Or the Women’s Health Initiative study of more than 16,000 women, which ended three years early because the HRT-treated women had more heart conditions, more strokes, more blood clots and 24 percent more breast cancer than those not taking the hormone.4 

I’m not in any way minimizing the trouble many women have during menopause. But I know of many natural and effective therapies to use instead of HRT that do not cause heart attacks, strokes or cancer.

So what we’re really talking about here is a temporary upset during a major transition in a woman’s life, which can cause many troubling symptoms like mood swings, hot flashes and brain fog, much as women talk about “baby brain” when they become new mothers and are making that transition.  

I take exception to the idea that women after 50 will suffer long-term cognitive decline unless given HRT.  A recent review of all the existing studies about whether HRT can prevent dementia concluded that there are “strong discrepancies” between individual studies, with the most recent trials showing “no beneficial effects.”5

The late Barbara Marx Hubbard liked to say that she was in the midst of a ‘regenepause’ in her 80s. Margaret Meade spoke of the post-menopausal “zest” of women. I certainly wrote my most important books at the time I was supposed to be dolally.

But then, maybe we are all just crazy old ladies.




Sci Rep, 2021; 11: 10867 


Neurology, 2016; 87: 887–96


Neurology, 2014; 82: 427–34


JAMA, 2002; 288: 321–33


Front Aging Neurosci, 2022; 14: 831807

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