Decades after the pill, another revolution

When the BBC reflected on the 50 things that made the modern economy a few years back, of course it included the pill. Oral contraception ushered in a revolution some 60 years ago that freed women to plan their lives. It meant many could enroll in graduate programs and pursue professional careers, raising long-term income levels and spurring far-reaching economic change.

There is no obvious equivalent today. And yet a new move in Britain to address inequalities in health care could prove almost as revolutionary for women — and for a country that, like many others, is experiencing slowing long-term growth trends and an aging population that is living longer.

The U.K. government promised last year to “reset the dial” on women's health, and its new strategy is due to be published in the spring. We'll have to reserve judgment until then, but last week Britain's medicines regulator took a step forward with a proposal to make hormone replacement therapy, used to treat menopause symptoms, available over the counter and at negligible charge.

There is now a consultation to make a single product — Estradiol, a vaginal estrogen — available to women over 50 without a prescription. Like the U.K.'s decision last year to make two forms of oral contraception available over the counter, this move comes with extremely low risks and takes a little pressure off over-stretched doctors. It would be a small change, but also a milestone.

For decades, conversation around menopause was either overheated, inhibited or just misinformed.

A minority are lucky enough to breeze through menopause. But 3 in 4 women will have symptoms that alter their quality of life, including trouble sleeping, hot flushes, brain fog, irritability, low moods or anxiety and urogenital problems. The fun lasts seven years, on average, but can go on for a decade or more. A quarter of women will experience severe symptoms, according to the British Menopause Society.

For most women, things really kick off around 50, but menopause has phases and many women experience symptoms from their mid-40s. This is lousy timing on nature's part. It comes just as women are at a high point in their careers, or are ready to launch new ones, and when they are dealing with the joys and strains of teenagers, older children leaving home or caring for elderly parents.

It's hard to find concrete data on the impacts on women's work outcomes, but there's no doubt menopause affects careers. In a U.K. survey conducted by YouGov, three out of five menopausal women reported their symptoms affected their work lives; nearly a third said they had taken sick leave because of symptoms, though only a quarter disclosed the reason to their managers. An October survey found that a quarter of women with serious symptoms left their jobs.

Scores of studies have confirmed that hormone therapy, of which there are many kinds, provides substantial relief from the most common symptoms. Many women find it gives them their lives back. In England, women can get a virtual consultation with a GP and a prescription costing just over 9 pounds ($12) for a three-month supply of a combined HRT (estrogen and progestogen); the government has introduced a bill to remove those costs and set out broader menopause support services. Costs in the U.S., even with insurance coverage, can easily run 10 times that.

The thing is, not all women are good candidates for all HRT, and even when no complications exist there are risks to consider. It's important that a medical professional trained in menopause treatment oversee things.

Quantifying risks isn't simple, as they vary by age, lifestyle, the kind of hormone, how long it's taken and even the form of delivery. The U.K. medicines regulator says that in those of average weight who use HRT for five years, there will likely be five extra cases of breast cancer per 1,000 women who use estrogenonly HRT, and 20 extra cases per 1,000 women with combined estrogen-progestogen therapy. HRT also carries a small increase in the risk of ovarian cancer. Both increased risks are reversed when HRT is stopped, so most women are generally advised to use HRT for five years or less.

Haitham Hamoda, a consultant gynecologist and chairman of the British Menopause Society, says that after years of heightened fears and some continued uncertainties, there is more acceptance now that the balance of benefits and risks is favorable for most women and that the risks have to be compared with other cancer risks factors, such as excess weight or lack of exercise.

The U.K.'s step toward making one targeted HRT product available over the counter may seem small. But the trend toward more menopause information and better access to a variety of treatments will bring other changes too. As with the pill last century, giving women more control over their bodies means they'll have more control over their lives.