The decrease in
estrogen levels in women
going through menopause has interested
doctors and patients for many years. Synthetic
estrogen was developed in the
1920's, and by the mid-1930's it was being
used to relieve menopausal symptoms. In
the mid-1960's, the book
Feminine Forever
touted the use of synthetic estrogen as a
way to maintain youth and femininity. This
book became a hit in the lay press and
greatly increased the demand for hormone replacement therapy (HRT).
HRT use decreased sharply when the connection
between use of synthetic estrogen
and elevated risk of endometrial cancer was
recognized in the 1970's. Use of HRT has
slowly gone up since the 1980's, when
long-term research established the protective
effects of HRT against
osteoporosis
and possibly
heart disease.
Improved treatment schedules and delivery
systems have increased HRT use in the
U.S. To minimize the risk of endometrial
cancer, physicians are much more likely to
give lower doses of estrogen and to combine
it with progesterone for women whose
uteruses are intact. Furthermore, many different
formulations and dosing schedules
now permit physicians to better tailor HRT
to each patient.
Although we know much more about HRT
today, controversy still surrounds its risks
and benefits. Those who caution against
using HRT use often cite the increased
risk of endometrial and breast cancer
associated with using estrogen, especially
for extended lengths of time, and its common side effects such as breast tenderness,
nausea, unpredictable bleeding,
bloating, and mood fluctuations. Those
who advocate using HRT frequently
point out that HRT appears not only to
alleviate menopausal symptoms, but also
to reduce the risk of osteoporosis, and
possibly heart disease and
Alzheimer'sdisease, all of which could have much
greater impact than cancers on the health
of postmenopausal women.
Until we have more definitive information
about HRT's effects on diseases,
each woman must, with the help of her
physician, weigh the risks and benefits
of use. Whether or not a woman uses
HRT depends on many factors: how she
perceives the risks and benefits of HRT
vs. the risks and potential harm of menopausal
symptoms and various diseases
affected by HRT; the information she
obtains from her physician about HRT;
and her access to health care.
Results from a 2003 European study linked HRT to the development of asthma in women.
In February 2004, the Food and Drug Administration requested that manufacturers update labeling for hormone therapy products (estrogen and combination estrogen and progestin products) for use by postmenopausal women with data from WHIMS-The Women's Health Initiative Memory Study. WHIMS reported an increased risk of dementia in women 65 and older and showed that estrogen with progestin (Prempro) failed to prevent mild cognitive impairment (memory loss). (WHIMS is a substudy of the Women's Health Initiative (WHI) conducted by the National Institutes of Health.)
Brett, KM, Chong Y.
Hormone Replacement Therapy:
Knowledge and Use in the United States.
Hyattsville, Maryland: National Center
for Health Statistics. 2001.View sub-topics at right to learn more about some specific drugs used in HRT and some of the drugs' more serious adverse side effects.
See Also
- Prescription & Over-the-Counter Drugs: Overview
- Estrogen
- Premarin
- Prempro / Premphase
- Progestin: Overview
- Alzheimer's Disease
- Asthma: Overview
- Balance Problems: Overview
- Blood Clots
- Breast Cancer
- Cancer
- Headaches
- Hearing Loss
- Heart Problems
- Memory Loss
- Stroke