In the days after Daphna Cardinale delivered her second child, she experienced a rare sense of calm and wonder. The feeling was a relief after so much worrying: She and her husband, Alexander, had tried for three years to conceive before turning to in vitro fertilization, and Daphna, once pregnant, had frequent and painful early contractions. But now, miraculously, here was their baby, their perfect baby, May, with black hair plastered on her head. (May is a nickname that her parents requested to protect her privacy.)Listen to this article, read by Julia WhelanBecause everything about May felt like an unexpected gift, Daphna was not surprised to find that she was an easy newborn: a good eater, a strong sleeper. The couple settled May into her lavender bedroom in their home in a suburb of Los Angeles. Daphna, on leave from her work as a therapist, was grateful for the bounty of two children, overjoyed that she could deliver to her older daughter, Olivia, then 5, the sister she had begged for since she could speak in full sentences.Alexander, a singer and songwriter, wanted to share his wife’s happiness, but instead he was preoccupied by a concern that he was reluctant to voice: May did not look to him like a member of their family. She certainly did not resemble him, a man of Italian descent with fair hair and light brown eyes, or Daphna, a redhead with Ashkenazi Jewish heritage. Alexander often turns to dark humor to mask a simmering anxiety, and in the days after the birth, he started to joke that their I.V.F. clinic had made a mistake. Later he would explain that the jokes were a kind of superstition, a way of warding off something threatening: If you say the horrible thing out loud, it won’t happen. But friends and family members were also commenting to him on the striking difference in appearance — Alexander’s mother, for example, told him, out of Daphna’s earshot, that she would have guessed that at least one of May’s parents was Asian.Alexander would convince himself that everything was fine, only to be walloped once again by the suspicion that May was not his genetic child. Daphna, who was accustomed to calming Alexander’s worries, quickly tired of his nervous jokes about the clinic. Looking back, she realized that her consciousness was working on two levels, that her mind was laboring not to see what was fairly obvious. She often sought reassurance from a baby photo of herself that her mother sent her, in which she closely resembled May. But occasionally, when Daphna looked in the mirror, she would see her own face and think it looked strange — as if there were something wrong with her.Daphna Cardinale with May at the hospital.From the Cardinale familyAlexander Cardinale at the hospital with Olivia and May.From the Cardinale familyWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

About a year ago, a friend of mine started evading my invitations to grab a drink. It was only when we caught up for a walk that she explained she wasn’t putting me off for any personal reason — it was just that she had stopped drinking. She wasn’t a heavy drinker — she had a glass of wine with dinner, the occasional Aperol spritz — but she’d been hearing on podcasts and reading in the news that even a small amount of alcohol was much worse for her health than had previously been understood. Listen to this article, read by Kirsten PotterMy friend was picking up on a swing in the public-health messaging around alcohol. For many years, she might have felt that she was making a healthy choice in having a glass of wine or a beer with dinner. Right around the time when she came of legal age to drink, the early 1990s, some prominent researchers were promoting, and the media helped popularize, the idea that moderate drinking — for women, a drink a night; for men, two — was linked to greater longevity. The cause of that association was not clear, but red wine, researchers theorized, might have anti-inflammatory properties that extended life and protected cardiovascular health. Major health organizations and some doctors always warned that alcohol consumption was linked to higher cancer risk, but the dominant message moderate drinkers heard was one of not just reassurance but encouragement.More recently, though, research has piled up debunking the idea that moderate drinking is good for you. Last year, a major meta-analysis that re-examined 107 studies over 40 years came to the conclusion that no amount of alcohol improves health; and in 2022, a well-designed study found that consuming even a small amount brought some risk to heart health. That same year, Nature published research stating that consuming as little as one or two drinks a day (even less for women) was associated with shrinkage in the brain — a phenomenon normally associated with aging.Drinking increased during the pandemic, which may be why news of any kind about alcohol seems to have found a receptive audience in recent years. In 2022, an episode of the podcast “Huberman Lab” that was devoted to elaborating alcohol’s various risks to body and brain was one of the show’s most popular of that year. Nonalcoholic spirits have gained such traction that they’ve started forming the basis for entire nightlife guides; and more people are now reporting that they consume cannabis than alcohol on a daily basis.Some governments are responding to the new research by overhauling their messaging. Last year, Ireland became the first country to pass legislation requiring a cancer warning on all alcohol products sold there, similar to those found on cigarettes: “There is a direct link between alcohol and fatal cancers,” the language will read. And in Canada, the government has revised its alcohol guidelines, announcing: “We now know that even a small amount of alcohol can be damaging to health.” The guidelines characterize one to two drinks a week as carrying “low risk” and three to six drinks as carrying “moderate risk.” (Previously the guidelines suggested that women limit themselves to no more than two standard drinks most days, and that men place that limit at three.)We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Listen to This ArticleAudio Recording by AudmIn my late 20s, living alone in New York, I found myself in the grip of a dark confusion, unclear of how to proceed — and so I started seeing a therapist. During most visits, I sat in a chair with a box of tissues on the small table beside it, but the office also held a couch, on which I occasionally reclined, staring at the ceiling as I wrestled with what I was doing with my life, and even what I was doing in that office. Back then, therapy was still perceived in some circles as a rarefied recourse for the irredeemably neurotic. I was embarrassed that I seemed to need it, and I could hardly afford the expense. It ate up so much of my pay that I sometimes daydream about the little house in the Catskills that I might now enjoy had I invested the money I spent on those twice-weekly sessions in any reputable mutual fund instead. Were they worth it? I know therapy provided me comfort, and I believe I developed some self-awareness, which has served me well. But during that phase of my life, I also spent more time than I should have, I’m sure, in a patently unhealthful relationship that my therapist and I endlessly discussed, as if it were a specimen to be dissected rather than discarded.Whatever my ambivalence about therapy, I trusted it enough to return to it several times, trying other modes that have become increasingly popular, including two versions of cognitive-behavioral therapy. More recently, I explored a form of therapy that had me locating my feelings in particular parts of my body so that I could — oh, I don’t know what, although I recall that I found it interesting at the time. Over the decades, and especially since the pandemic, the stigma of therapy has faded. It has come to be perceived as a form of important self-care, almost like a gym membership — normalized as a routine, healthful commitment, and clearly worth the many hours and sizable amounts of money invested. In 2021, 42 million adults in the United States sought mental-health care of one form or another, up from 27 million in 2002. Increasingly, Americans have bought into the idea that therapy is one way they can reliably and significantly better their lives. As I recently considered, once again, entering therapy, this time to adjust to some major life transitions, I tried to pinpoint how exactly it had (or had not) helped me in the past. That train of thought led me to wonder what research actually reveals about how effective talk therapy is in improving mental health. Occasionally I tried to raise the question with friends who were in therapy themselves, but they often seemed intent on changing the subject or even responded with a little hostility. I sensed that simply introducing the issue of research findings struck them as either threatening or irrelevant. What did some study matter in the face of the intangibles that enhanced their lives — a flash of insight, a new understanding of an irrational anger, a fresh recognition of another’s point of view? I, too, have no doubt that therapy can change people’s lives, and yet I still wanted to know how reliably it offers actual relief from suffering. Does therapy resolve the symptoms that cause so much pain — the feeling of dread in people who deal with anxiety, or insomnia in people who are depressed? Does the talking cure, in fact, cure? And if it does, how well? Sigmund Freud, the brilliant if dogmatic father of psychoanalysis, was famously uninterested in submitting his innovation to formal research, which he seemed to consider mere bean-counting in the face of his cerebral excavations of the unconscious. Presented with encouraging research that did emerge, Freud responded that he did not “put much value on these confirmations because the wealth of reliable observations on which these assertions rest make them independent of experimental verification.” A certain skepticism of the scientific method could be found in psychoanalytic circles well into the late 20th century, says Andrew Gerber, the president and medical director of a psychiatric treatment center in New Canaan, Conn., who pursued the use of neuroimaging to research the efficacy of therapy. “At my graduation from psychoanalytic training, a supervising analyst said to me, ‘Your analysis will cure you of the need to do research.’”Over time, formal psychoanalysis has largely given way to less-​libido-focused talk therapies, including psychodynamic therapy, a shorter-term practice that also focuses on habits and defenses developed earlier in life, and cognitive-behavioral therapy, which helps people learn to replace negative thought patterns with more positive ones. Hundreds of clinical trials have now been conducted on various forms of talk therapy, and on the whole, the vast body of research is quite clear: Talk therapy works, which is to say that people who undergo therapy have a higher chance of improving their mental health than those who do not. That conviction gained momentum in 1977, when the psychologists Mary Lee Smith and Gene V. Glass published the most statistically sophisticated analysis on the subject until that point. They looked at some 400 studies in a paper known as a meta-analysis — a term Glass coined — and found that among the “neurotics” and “psychotics” who had undergone various kinds of talk therapy, the typical patient fared better than 75 percent of those with similar diagnoses who went untreated. The finding that therapy has real benefits was replicated numerous times in subsequent years, in analyses applied to patients with anxiety, depression and other prevalent disorders.“I think the evidence is fairly clear that psychotherapy is remarkably effective,” says Bruce Wampold, a prominent researcher in the field who is an emeritus professor of counseling psychology at the University of Wisconsin-Madison. To him, the power of such a low-tech treatment is nothing short of miraculous, especially given that studies typically follow patients for 20 sessions or fewer: “The fact that you can just go talk to another human being — I mean, it’s more than just talking — and get effect sizes that are measurable, and remarkably large?” Wampold is best known for research suggesting that all types of evidence-based talk therapies work equally well, a controversial phenomenon known as the Dodo Bird effect. (The effect takes its name from the Dodo in “Alice’s Adventures in Wonderland,” who, when asked to judge a race, decrees, “Everybody has won, and all must have prizes!”) Hash out your childhood with a psychodynamic therapist, write down probabilities of feared outcomes with a cognitive-behavioral therapist, work on your boundaries with an interpersonal therapist — they will all yield equally positive results, found Wampold and others who have replicated his work. But there are reasons to think that this picture of therapy overpromises. As is true of much research, studies with less positive or striking results often go unpublished, so the body of scholarly work on therapy may show inflated effects. And researchers who look at different studies or choose different methods of data analysis have generated more conservative findings. Pim Cuijpers, a professor of clinical psychology at Vrije University in Amsterdam, co-wrote a 2021 meta-analysis confirming that therapy was effective in treating depression compared with controls, but he also found that more than half of the patients receiving therapy had little or no benefit and that only a third entered “remission” (meaning their symptoms lessened enough that they no longer met the study’s criteria for depression). Given that the patients were assessed just one to three months after treatment started, Cuijpers said he considered those results “a good success rate,” but he also noted that “more effective treatments are clearly needed” because so many patients did not meaningfully benefit. A blunter assessment of short-term therapies appears in a 2022 paper published by Falk Leichsenring and Christiane Steinert, psychotherapists and researchers affiliated with universities in Germany, who surveyed studies comprising some 650,000 patients suffering from a broad range of mental illnesses. “After more than half a century of research” and “millions of invested funds,” they wrote, the impact that therapy (and medication, for that matter) had on patients’ symptoms was “limited.”Such different interpretations of the data persist in part because of some of the field’s particular research challenges, starting with what constitutes a suitable control group. Many researchers put half the people who sign up to participate in a trial on a waiting list, in order to use that cohort as a control group. But critics of that method argue that languishing on a waiting list puts patients in an uncomfortable state of limbo, or makes them less likely to seek help from other sources, thus inflating the difference between their well-being and the well-being of those who received care. Other researchers try to provide a control group by offering a neutral nontherapy therapy, but even those are thought to have some placebo effect, which could make the effect of therapy look smaller than it really is. (One researcher, in trying to devise a neutral form of therapy to serve as a control, even managed to stumble on a practice that improved patients’ well-being about as well as established therapies.) So the debate continues, not just about the extent of therapy’s effectiveness but about the notion of the Dodo Bird effect. Many proponents of cognitive-behavioral therapy insist on the superiority of their approach for the treatment of depression and anxiety by pointing to competing meta-analyses. David Tolin, director of the Anxiety Disorders Center at the Institute of Living in Hartford, Conn., wrote one such meta-analysis. “Cognitive-behavioral therapy has a small to medium advantage over psychodynamic therapy,” he says. Nonetheless, he finds the measured results of cognitive-behavioral therapy to be unsatisfying, in his own research and in others’. He points to another meta-analysis of cognitive-behavioral therapy and anxiety disorders that found that only 50 percent of patients responded to the treatment. “It is not what I would call a home run,” he told me. Tolin has started to wonder if it’s time for research to shift away from talk therapy toward more innovative strategies. Leichsenring, too, has called for a “paradigm shift” in order to make further progress. For depression, there’s some evidence that therapy plus psychiatric medications is more effective than therapy or medication alone. Tolin believes that researchers should be focusing more attention on drugs that work in novel ways, such as one that has been shown to stimulate the same neurons that are active during cognitive-behavioral therapy. “Maybe we have reached the limit of what you can do by talking to somebody,” Tolin says. “Maybe it’s only going to get so good.” Illustration by Dadu ShinEllen Driessen is a psychologist in the Netherlands who believes, to the contrary, that the field has not yet unlocked the full potential of talk therapy. Driessen’s Twitter bio describes her as a “passionate depression treatment researcher,” and she has devoted herself in recent years to finding ways to maximize therapy’s effectiveness. Her goal: to determine which kinds of therapies work best for which kinds of patients, in the hope that those targeted pairings will yield better results. In her own practice, when patients turn to her for guidance about what treatment to choose, she often feels frustrated by uncertainty. The finding that all types of therapy work equally well, Driessen believes, could be hiding the variation that exists from person to person. Given the state of research, it is impossible to know what to recommend for an individual patient. “I don’t know which of these treatments will work best for you,” she resorts to saying. “And that is something that I, as a clinician, find very unsatisfying.”Most studies do not break down the results of various psychotherapies by type of patient — by gender, for example, or comorbidities, or age of onset of illness. The trials are too small to generate statistically meaningful results for those categories. Driessen and colleagues are undertaking the ambitious task of going back to the researchers on at least 100 trials to procure identifying details about patients, so that their samples will be large enough to allow them to determine whether certain kinds of people are more likely to respond to one kind of therapy or another. The project will most likely be underway for a decade before they can tease out matches between practice and patient. Another growing school of research, meanwhile, hopes to move practitioners away from adhering strictly to one school or another, by identifying the most effective components of each — the practice of exposing patients to the sources of their fears, for example, or examining relationship patterns. But Wampold believes that eventually these researchers will simply land, with their collection of techniques, on yet another form of therapy that proves about as effective as all the others. The most significant difference in patient outcomes, Wampold says, almost always lies in the skills of the therapist, rather than the techniques they rely on. Hundreds of studies have shown that the strength of the patient-therapist bond — a patient’s sense of safety and alignment with the therapist on how to reach defined goals — is a powerful predictor of how likely that patient is to experience results from therapy. But what distinguishes the therapists most likely to forge those bonds is not intuitive. Wampold says that some of the attributes that would seem most salient — a therapist’s agreeability, years of training, years of experience — do not correlate at all with effectiveness of care. To demonstrate the skills that do correlate, Timothy Anderson, director of the Psychology & Interpersonal Process Lab at Ohio University, studied groups of therapists who have been rated by patients as highly effective. He put them through a monitored exercise in which they were asked to respond to video clips featuring actors playing out difficult situations that commonly arise in therapy. “The patient might be saying, ‘This isn’t working — you can’t help me,’” Anderson says. He found that the highest-rated therapists tended, in those moments, to avoid responding with hostility or defensiveness, but instead replied with a pairing of language and tone that fostered a positive bond. “That’s displayed by the therapist saying things like, ‘We’re in this together,’” Anderson told me, “even when the patient is saying, ‘You can’t help me no matter what.’” Among the other qualities that these therapists displayed were verbal fluency — the ability to speak clearly in ways the patient could quickly grasp — along with an ability to persuade the patient and to focus on a specific problem. A certain humility in the face of the field’s uncertainties also seems to help; on a different questionnaire, therapists whose care was more successful gave responses that “reflected self-questioning about professional efficacy in treating clients.” For the past four years, Anderson says, he has been running workshops that aim to train therapists in these various skills. “Can we do it in brief workshops?” he says. “I’m not sure that we can.” Empathy, a capacity for alliance building — these might be innate, elusive, alchemic gifts that are challenging to teach. Anderson believes that people who become therapists tend to have more of those qualities than the general population, but he also referred to a study from the 1970s suggesting that laypeople who naturally have those skills performed nearly as well in therapeutic simulations as trained therapists with Ph.D.s. Is the idea, I asked Anderson, that patients should seek out therapists with whom they personally connect? That, just as most happy couples are made up of people who failed in previous relationships, the challenge lies in finding the right chemistry? Or is it more absolute? That perhaps some therapists are universally gifted at forging those bonds and can do so effectively with almost any patient. “They could both be true,” Anderson said. The answer struck me as yet another frustrating unknown in the field. I had perhaps — as a longtime consumer of therapy in search of reassurance — hit my limit with the disputes among the various clinicians and researchers, the caveats and the debates over methodology. “The research seems very … baggy,” I said, not bothering to hide my frustration. “It’s not very satisfying.” I could practically hear a smile on the other end of the phone. “Well, thank you,” Anderson said. “That’s what makes this research so interesting. That there are no simple answers, right?” A handful of well-chosen words — and I felt soothed, even touched by his positivity, which included, with that question mark at the end of his sentence, a hint of inclusiveness. Confronted with my clear annoyance, he had offered me a nondefensive, constructive and positive response. We were in this together. The exchange made me think of the best hours I have spent in therapy, times when I felt the depth of a therapist’s caring, or experienced the reframing of a particular thought that I hadn’t even known could be cast in so different a light. The therapist Stephen Mitchell has described therapy as a “shared effort to understand and make use of the pains and pleasures of life’s experiences.” Therapy, in his language, is not a practice that tries to fix any one thing, but one that aspires to help its participants build the most out of the challenges that face them. Jonathan Shedler, a psychodynamic psychologist and vocal critic of the research on therapy, believes that the field, in its narrow focus on reducing symptoms, fails to capture other ways patients benefit from psychodynamic therapy. “It’s not a fair comparison to look at how they’re doing the day therapy ends,” he says. “We’re aiming to go farther — to change something fundamental, so that people can feel more at peace with themselves and have more meaningful connections with others.”Anderson and I had set aside a half-hour to talk about therapist skills, and as the minutes passed, I felt that familiar sensation of the clock ticking, even as I wished he and I could keep talking — there was so much to discuss. Alas, he gently conveyed, our time was up.Dadu Shin is an illustrator in Brooklyn who has worked for clients like The New York Times and Armani Exchange. His work focuses on emotion and empathy.

Listen to This ArticleAudio Recording by AudmTo hear more audio stories from publications like The New York Times, download Audm for iPhone or Android.For the past two or three years, many of my friends, women mostly in their early 50s, have found themselves in an unexpected state of suffering. The cause of their suffering was something they had in common, but that did not make it easier for them to figure out what to do about it, even though they knew it was coming: It was menopause.The symptoms they experienced were varied and intrusive. Some lost hours of sleep every night, disruptions that chipped away at their mood, their energy, the vast resources of good will that it takes to parent and to partner. One friend endured weeklong stretches of menstrual bleeding so heavy that she had to miss work. Another friend was plagued by as many as 10 hot flashes a day; a third was so troubled by her flights of anger, their intensity new to her, that she sat her 12-year-old son down to explain that she was not feeling right — that there was this thing called menopause and that she was going through it. Another felt a pervasive dryness in her skin, her nails, her throat, even her eyes — as if she were slowly calcifying.Then last year, I reached the same state of transition. Technically, it is known as perimenopause, the biologically chaotic phase leading up to a woman’s last period, when her reproductive cycle makes its final, faltering runs. The shift, which lasts, on average, four years, typically starts when women reach their late 40s, the point at which the egg-producing sacs of the ovaries start to plummet in number. In response, some hormones — among them estrogen and progesterone — spike and dip erratically, their usual signaling systems failing. During this time, a woman’s period may be much heavier or lighter than usual. As levels of estrogen, a crucial chemical messenger, trend downward, women are at higher risk for severe depressive symptoms. Bone loss accelerates. In women who have a genetic risk for Alzheimer’s disease, the first plaques are thought to form in the brain during this period. Women often gain weight quickly, or see it shift to their middles, as the body fights to hold onto the estrogen that abdominal fat cells produce. The body is in a temporary state of adjustment, even reinvention, like a machine that once ran on gas trying to adjust to solar power, challenged to find workarounds.I knew I was in perimenopause because my period disappeared for months at a time, only to return with no explanation. In the weeks leading up to each period, I experienced abdominal discomfort so extreme that I went for an ultrasound to make sure I didn’t have some ever-growing cyst. At times, hot flashes woke me at night, forcing me straight into the kinds of anxious thoughts that take on ferocious life in the early hours of morning. Even more distressing was the hard turn my memory took for the worse: I was forever blanking on something I said as soon as I’d said it, chronically groping for words or names — a development apparent enough that people close to me commented on it. I was haunted by a conversation I had with a writer I admired, someone who quit relatively young. At a small party, I asked her why. “Menopause,” she told me without hesitation. “I couldn’t think of the words.”‘It suggests that we have a high cultural tolerance for women’s suffering. It’s not regarded as important.’My friends’ reports of their recent doctors’ visits suggested that there was no obvious recourse for these symptoms. When one friend mentioned that she was waking once nightly because of hot flashes, her gynecologist waved it off as hardly worth discussing. A colleague of mine seeking relief from hot flashes was prescribed bee-pollen extract, which she dutifully took with no result. Another friend who expressed concerns about a lower libido and vaginal dryness could tell that her gynecologist was uncomfortable talking about both. (“I thought, hey, aren’t you a vagina doctor?” she told me. “I use that thing for sex!”)Their doctors’ responses prompted me to contemplate a thought experiment, one that is not exactly original but is nevertheless striking. Imagine that some significant portion of the male population started regularly waking in the middle of the night drenched in sweat, a problem that endured for several years. Imagine that those men stumbled to work, exhausted, their morale low, frequently tearing off their jackets or hoodies during meetings and excusing themselves to gulp for air by a window. Imagine that many of them suddenly found sex to be painful, that they were newly prone to urinary-tract infections, with their penises becoming dry and irritable, even showing signs of what their doctors called “atrophy.” Imagine that many of their doctors had received little to no training on how to manage these symptoms — and when the subject arose, sometimes reassured their patients that this process was natural, as if that should be consolation enough.Now imagine that there was a treatment for all these symptoms that doctors often overlooked. The scenario seems unlikely, and yet it’s a depressingly accurate picture of menopausal care for women. There is a treatment, hardly obscure, known as menopausal hormone therapy, that eases hot flashes and sleep disruption and possibly depression and aching joints. It decreases the risk of diabetes and protects against osteoporosis. It also helps prevent and treat menopausal genitourinary syndrome, a collection of symptoms, including urinary-tract infections and pain during sex, that affects nearly half of postmenopausal women.Marta Blue for The New York TimesMenopausal hormone therapy was once the most commonly prescribed treatment in the United States. In the late 1990s, some 15 million women a year were receiving a prescription for it. But in 2002, a single study, its design imperfect, found links between hormone therapy and elevated health risks for women of all ages. Panic set in; in one year, the number of prescriptions plummeted. Hormone therapy carries risks, to be sure, as do many medications that people take to relieve serious discomfort, but dozens of studies since 2002 have provided reassurance that for healthy women under 60 whose hot flashes are troubling them, the benefits of taking hormones outweigh the risks. The treatment’s reputation, however, has never fully recovered, and the consequences have been wide-reaching. It is painful to contemplate the sheer number of indignities unnecessarily endured over the past 20 years: the embarrassing flights to the bathroom, the loss of precious sleep, the promotions that seemed no longer in reach, the changing of all those drenched sheets in the early morning, the depression that fell like a dark curtain over so many women’s days.About 85 percent of women experience menopausal symptoms. Rebecca Thurston, a professor of psychiatry at the University of Pittsburgh who studies menopause, believes that, in general, menopausal women have been underserved — an oversight that she considers one of the great blind spots of medicine. “It suggests that we have a high cultural tolerance for women’s suffering,” Thurston says. “It’s not regarded as important.”Even hormone therapy, the single best option that is available to women, has a history that reflects the medical culture’s challenges in keeping up with science; it also represents a lost opportunity to improve women’s lives.“Every woman has the right — indeed the duty — to counteract the chemical castration that befalls her during her middle years,” the gynecologist Robert Wilson wrote in 1966. The U.S. Food and Drug Administration approved the first hormone-therapy drug in 1942, but Wilson’s blockbuster book, “Feminine Forever,” can be considered a kind of historical landmark — the start of a vexed relationship for women and hormone therapy. The book was bold for its time, in that it recognized sexual pleasure as a priority for women. But it also displayed a frank contempt for aging women’s bodies and pitched hormones in the service of men’s desires: Women on hormones would be “more generous” sexually and “easier to live with.” They would even be less likely to cheat. Within a decade of the book’s publication, Premarin — a mix of estrogens derived from the urine of pregnant horses — was the fifth-most-prescribed drug in the United States. (Decades later, it was revealed that Wilson received funding from the pharmaceutical company that sold Premarin.)Your Questions About Menopause, AnsweredCard 1 of 6What are perimenopause and menopause?