Although it has been known since 1937, estrogen replacement therapy (ERT) didn’t come about until the late 1950s during the post-war years when there was a strong excitement for controlling the natural environment with chemicals. Pharmaceutical companies were discovering strong financial gains from the philosophy, “For every human ailment there is a drug that will cure it.”

ERT reached the public in 1964 when gynecologist Robert A Wilson introduced his estrogen-based product, Premarin, to the market. The January 13, 1964, issue of “Newsweek” carried a one-page story entitled “No More Menopause?” reporting on Dr. Wilson and how he had been studying menopause since the 1920s. He reached the conclusion that “change of life” stemmed from a lack of the female hormones estrogen and progesterone.

Women jumped on the ERT bandwagon from 1965 to the 1970s. Around 1975, women who used ERT started developing uterine (endometrial cancer) at a rate four to eight times higher than women who didn’t take the pills.  Although medical doctors failed to link ERT therapy directly to endometrial cancer, they decided to take what they believed to be a safer approach, by adding progestins (synthetic versions of progesterone) to the estrogen and calling it hormone replacement therapy (HRT). Research showed that estrogen plus progesterone therapy actually prevented endometrial cancer.

Throughout the years, promoters of HRT were supposedly finding evidence that this therapy reduced the risk heart disease and osteoporosis. According to Katie Burns-Ryan, DC, an associate professor and faculty clinician at Northwestern Health Sciences University, women were left on HRT for years and there really wasn’t a time limit because they were unaware of the risks the therapy posed until recently.

In 1991, the Women’s Health Initiative, launched by the National Heart, Lung, and Blood Institute and other working units of the National Institutes of Health, began one of the largest studies ever undertaken in the United States. The studies came to the conclusion that HRT poses more serious health risks including an increase in stroke, blood clots, and breast cancer, which exceed the benefits it provides.

The clinical trials were designed to test the effects of two types of HRT now referred to as menopausal replacement therapy (MHT), including estrogen-plus-progestin and estrogen-alone. The first involved 16,608 women with a uterus who either took estrogen-plus-progestin therapy or a placebo. The second involved 10,739 women who had a hysterectomy and took estrogen-alone. Both studies planned to continue until 2005 but the estrogen-plus-progestin study was stopped in July 2002 and the estrogen-alone study at the end of February 2004.

The combination therapy study was stopped because of an increased risk of breast cancer, heart attack, stroke and blood clots over the five and a half years of the trial. The estrogen-alone study was stopped after almost seven years because of an increased risk of stroke and blood clots. The study also found that both therapies increased the rate of dementia, including Alzheimer’s in women. The major benefit of both therapies is that they both decrease the risk of hip fractures and help in the prevention of osteoporosis.

The U.S. Food and Drug Administration (FDA) encourages health care providers to consider other treatments before providing MHT for the prevention or treatment of osteoporosis. The FDA also recommends that MHT should be used at the lowest doses for the shortest duration to reach treatment goals, if used at all. It’s best to consult with your health care provider to determine what treatments are best for you depending on your symptoms and health history.

Sources: John R. Lee. M.D., and Virginia Hopkins, What Your Doctor May Not Tell You About Menopause: The Breakthrough Book On Natural Progesterone (1996), Time Warner Books, Inc, pgs. 21-26; and the U.S. Department of Health and Human Services.