While researching a project on the Indian woman’s experience of menopause, I chanced upon a clinic in a north Mumbai suburb with a freshly-painted board advertising a ‘Clinic for Elderly Women. The doctor (who turned out to be a general practitioner) saying I could sit in on consultations if the patient did not mind.

The patient was a 49-year-old woman, S, whose complaint was a constant body ache, head aches, depression and a general feeling of being useless. She said she often felt suicidal but “even that seemed like too much work.” Her children had grown up and left the house. Her husband travels frequently, leaving her alone. “When my husband is away, I am very lonely. I have nice neighbours but I miss my family. I can’t do without the TV and eat all the time. My husband tells me I look too fat.” She believes he no longer finds her attractive.

After listening to S’s litany of complaints the doctor asked her age and her menstrual pattern. She had not menstruated for over a year. With this two brief queries the doctor wrote out a prescription for Estriol, a lower dose (and currently the cheapest) Hormone Replacement Therapy drug, told S to take it twice a day and asked for a fee of Rs 175. The entire visit took barely 15 minutes.

The doctor did not ask S about her family medical history: he did not tell her what she was taking, the possible side effects, the need for monitoring. He simply told her that she would get complete ‘shanti’ with the drug, and that she could take it for the rest of her life, though Estriol is normally prescribed for a three-month period with the possibility of another three months if there has been no relief. Estriol is normally recommended to menopausal patients complaining of common physiological symptoms of menopause.

Speaking with S outside the clinic, I asked her if there was a family history of breast cancer or diabetes, and if she herself had gall stones (all contraindications for HRT use). She said no, but, if someone had cancer or diabetes we would not have known.

The doctor said it was S’s first visit to him. Why did he suggest that she go on HRT? “Didn’t you hear’! She said she no longer menstruated. Estriol is very good for women of this age .” Further questions about contraindications for HRT use were dismissed with a wave of his hand. I asked him whether, in his capacity as a GP, he felt confident about prescribing hormonal treatment. He said, “All the medical reps say it is the best thing for ageing women. They say that every doctor buys it.” I asked him when he had first heard of HRT. He said a medical representative had introduced him to it about two years ago but he had started prescribing it only recently.

Such incidents highlight the frightening lack of knowledge amongst some sections of the medical professsion about the contraindications of HRT. It also points to the desperate need for counselling services. There is a growing belief that most women would benefit more from counselling than clinical interventions like HRT.