For decades it was commonly used yet the news went back-and-forth on research. Then, when the pharmaceutical companies were losing courtroom battles over improperly advertised benefits of replacing HRT-NPVestrogen the confusion worsened.  What was going on?  Why had such a wonderful therapy suffered a major setback?  After all, most women who used estrogen and hormone replacement reported wonderful improvements from the symptoms of menopause. Menopause was not just a headache or the ending of the menstrual cycle, but often a decade-long or longer process.  These replacements had entered the therapeutic landscape at just the right time!  Still, in a world where informed decision is the priority, a woman needs to know what has taken place in the research, legal, and medical worlds.  The reality is that estrogen and hormone replacement is still okay for use under certain, defined options and women should be aware of these options. 

Starting about 51 years-of-age the natural process of menopause involves a loss in the normal cycling of estrogen.   The pituitary, which drives the cycle from a balance of follicle stimulating hormone (FSH) and luteinizing hormone (LH) has changed its ratio.  Estrogen replacement therapy adds to the depleted estrogen to relieve the symptoms of menopause.  Some women still have their uterus, and progestin is added for hormone replacement to protect the uterine lining from risk of cancer (Grady, Gebretsadik, Kerlikowske, Ernster, & Petitti, 1995). 

Many women have concerns about the source of hormones since prescriptions are manufactured from estrogens using pregnant horse urine (Sitruk-Ware, 2002).  Some have considered instead using plant estrogens (phytoestrogens).  This idea, after all, fits the pattern that natural products for most vitamins and medications is acceptable.  Also, since many of the insurance companies are no longer funding estrogen or hormone replacement prescriptions, this option seems viable.  After Glazier & Bowman (2001), performed a detailed analysis of all research between 1966 and 1999 they found no convincing data to show plant estrogens have equivalent potency to animal-based, prescription replacement medication.

Initially, estrogen replacement was available in the 1960’s, and 1970’s as a single hormone regimen to treat the menopausal symptoms of night sweats and hot flushes and the subsequent risk for osteoporosis or brittle bones.   Over time, the pharmaceutical companies began to sponsor limited research and later promoted “unlabeled” use of estrogen for more diseases and risks of illnesses.  These included heart disease, breast cancer, endometrial (inner lining of the uterus) cancer, colon cancer, dementia and mental loss, and deep vein clotting of the legs.   Curiously, while the U.S Food and Drug Administration licensed estrogen and hormone replacement for postmenopausal symptoms and to prevent osteoporosis, it never approved them for additional items, most notably heart disease prevention (Michels & Manson, 2003).

After the Women’s Health Initiative (WHI) study by Beral, et al. (1997), which investigated the increased risk of women for breast cancer who took estrogen supplement prescriptions, the tide turned against widespread use of these medications.  There was much fear in the industry for approximately a decade, but with time common sense prevailed.  Defects were found in the study and pockets of therapeutic options were identified that truly benefited women.  Specifically these were healthy postmenopausal women less than 60 years-of-age where risks for new cases of blood clots in the veins or heart failure are insignificant (Pines, 2010).  As a result, the professions such as the American Association of Clinical Endocrinologists and the American College of Obstetricians and Gynecologists returned to their former positions supporting estrogen and hormone replacement, but for more defined options of quality of life and life expectancy improvement (Pines, 2010).

The news media promoted only the negative features of estrogen and hormone replacement.  When the negative research findings and pharmaceutical courtroom dramas subsided, women did not hear the remaining positive options.  It is clear estrogen replacement is not available for the many things it once was advertised to be.  Still, for overwhelming postmenopausal symptoms you have full professional support to use it on an interim basis (Manson, 2010).   Health care providers now use quality of life when factoring risks-versus-benefits for postmenopausal treatment options.  If you are struggling with poor sleep or sex life issues, these are valid concerns.  You should consider the estrogen replacement option when making an informed decision.  Short duration therapy is still okay.   

 

References:

American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. (2008). COG Committee Opinion No. 420, November 2008: Hormone therapy and heart disease. Obstet Gynecol, 112, 1189–92. doi: 10.1097/AOG.0b013e31818e8782.

American College of Obstetricians and Gynecologists. (1998). Hormone replacement therapy. Educational Bulletin. Obstet Gynecol, 91(5), 1-9. doi:10.1016/0020-7292(93)90709-6.

Barrett-Connor, E. & Stuenkel, C. A. (2001). Hormone replacement therapy (HRT) — risks and benefits. Int. J. Epidemiol, 30(3), 423-6. doi: 10.1093/ije/30.3.423.

Beral, V., Banks, E., Reeves, G., & Bull, D. (2003). Breast cancer and hormone-replacement therapy: the Million Women Study. The Lancet, 362(9392), 1330-31. Retrieved May 14, 2014 from http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673603145965.pdf?id=qaawwU9p7-_P98ruqA8xu.

Beral, V., et al. (1997). Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52, 705 women with breast cancer and 108, 411 women without breast cancer. Lancet, 350(9084), 1047-59. Retrieved May 14, 2014 from http://ccp.ucr.ac.cr/bvp/pdf/cancer/rosero65.pdf.

Bluming, A. Z. (2004). Hormone replacement therapy. Geriatrics, 59(11).

Daly, E., et al. (1996). Risk of venous thromboembolism in users of hormone replacement therapy. The Lancet, 348(9033), 977-80. doi:10.1016/S0140-6736(96)07113-9.

Glazier, M. G., & Bowman, M. A. (2001). A review of the evidence for the use of phytoestrogens as a replacement for traditional estrogen replacement therapy. Archives of Internal Medicine, 161(9), 1161-72. doi:10.1001/archinte.161.9.1161.

Grady, D., Gebretsadik, T., Kerlikowske, K., Ernster, V., & Petitti, D. (1995). Hormone replacement therapy and endometrial cancer risk: a meta-analysis. Obstetrics & Gynecology, 85(2), 304-313.

Gutthann, S. P., Rodriguez, L. G., Castellsague, J., & Oliart, A. D. (1997). Hormone replacement therapy and risk of venous thromboembolism: population based case-control study. BMJ: British Medical Journal, 314(7083), 796. Retrieved May 14, 2014 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2126205/pdf/9081000.pdf.

Hickey, M., Elliott, J., & Davison, S. L. (2012). Hormone replacement therapy. BMJ, 344, e763. Retrieved May 14, 2014 from http://www.epocrates.com/dacc/1205/hrt1205BMJ.pdf.

Lacey Jr, J. V., et al. (2002). Menopausal hormone replacement therapy and risk of ovarian cancer. Jama, 288(3), 334-41. doi:10.1001/jama.288.3.334.

Manson, J. E. (2010, October). HORMONE REPLACEMENT THERAPY. In Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches: Workshop Summary. National Academies Press. (pp. 89-104). ISBN 9780309119887.

Michels, K.B. & Manson, J. E. (2003). Postmenopausal Hormone Therapy: A reversal of fortune. Circulation, 107, 1830-3.  doi: 10.1161/​01.CIR.0000064601.65196.DF.

Nabulsi, A. A., et al. (1993). Association of hormone-replacement therapy with various cardiovascular risk factors in postmenopausal women. New England Journal of Medicine, 328(15), 1069-1075. doi:10.1056/NEJM199304153281501.

Pines, A. (2010). Guidelines and recommendations on hormone therapy in the menopause. J Midlife Health. 1(1),41–2. doi: 10.4103/0976-7800.66990.

Ross, R. K., Paganini-Hill, A., Wan, P. C., & Pike, M. C. (2000). Effect of hormone replacement therapy on breast cancer risk: estrogen versus estrogen plus progestin. Journal of the National Cancer Institute, 92(4), 328-32. Retrieved May 14, 2014 from http://jnci.oxfordjournals.org/content/92/4/328.full.pdf+html.

Sitruk-Ware, R. (2002). Hormonal replacement therapy. Reviews in Endocrine and Metabolic Disorders, 3(3), 243-56. doi:10.1023/A:1020028510797.

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