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Hormone Replacement Therapy


The History of Hormone Replacement

Every year after age 25, our organs produce fewer hormones, which are molecules your body makes to give signals to your cells for a variety of health-maintaining functions. Both men and women have the same hormones, although in different ratios, and therefore both are at risk for hormonal deficiencies and imbalances. Hormone replacement therapy has been used for decades to give back lost hormone levels and to treat symptoms caused by these imbalances; estrogen therapy has been used to treat symptoms of menopause since 1930.

Hormone therapy really took off in 1966, when Dr. Robert A. Wilson wrote a book called Feminine Forever that publicized the use of estrogen to treat the "completely preventable" condition of menopause. In 1977, however, Barbara Seaman's book Women and the Crisis in Sex Hormones alerted women to the risks of hormone therapy, including the potential increased risk for breast cancer and heart disease.

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During the 1980s and 1990s, many studies began to suggest that hormone replacement not only relieved symptoms of hormonal imbalance but also protected women against cardiovascular disease and osteoporosis, contrary to Seaman's book. In support of Women and the Crisis in Sex Hormones, the HERS study in 1998 found that women with heart disease who used hormones had worse outcomes than those who did not take hormones.

"If you would replace a vitamin/mineral deficiency with a bioidentical vitamin/mineral, then you should replace a hormone deficiency with a bioidentical hormone."

Sangeeta Pati, MD, Fellow of the American College of Obstetricians and Gynecologists

The Women's Health Initiative (WHI) Study

The back-and-forth battle about the safety of hormone replacement seemed to really stick on the unsafe side as a result of the findings from the Women's Health Initiative (WHI) study in 2002. This large study investigated the health effects of the widely-used Prempro, which is made of conjugated equine estrogen (CEE) and a progestin called medroxyprogesterone acetate (MPA/Provera).

Based on the results from the study, researchers estimated that among 10,000 women taking Prempro for a year, compared to placebo, there would be:

  • 7 more cases of coronary heart disease
  • 18 more cases of blood clots
  • 8 more cases of stroke
  • 8 more cases of breast cancer
  • 6 fewer cases of colon cancer
  • 6 fewer cases of hip fracture

All in all, 97.5% of women on hormone treatment had no events in the WHI study, but the increased risk for cardiovascular disease and breast cancer resulted in millions of women stopping their hormone treatments.

What's Wrong With the WHI Study?

The outcome of the study was not a surprise to many people. The average age of the women in the study was 63; there was therefore a high rate of pre-existing disease, which may have skewed the health risks. Further, the women involved in the study may not have been truly eligible for hormone replacement therapy.

A large flaw in the study was that it did not take into account any physiological differences between the women and gave them identical doses of hormones.

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