Hormone therapy for post-menopausal women was once one of the most common treatments in America, according to the New York Times. That all changed in 2002 when a major study raised serious health concerns supposedly due to hormone replacement. Many doctors stopped prescribing hormones after the landmark study and many patients are afraid to ask. According to the New York Times:
Women of all ages have an increased risk of breast cancer after about five years of taking hormones.At highest risk from hormone use are women who have had a heart attack, breast cancer or a stroke or clot, or women with a cluster of significant health problems.Fears of hormone therapy are mostly rooted in an important but imperfect study from 2002.
Over the years I’ve heard that hormone replacement increases heart disease, then later that it reduced the risk of heart disease. At the same time there are numerous medical symptoms (listed below) that explains why women routinely took hormone replacement. Any drug therapy must be balanced between negative side effects and positive benefits. This from the New York Times:
There has long been an effective, F.D.A.-approved treatment for several of these symptoms, known as menopausal hormone therapy, but because of fear and misinformation, too few women have a clear picture of its risks and benefits.Hormone therapy has been shown to ease hot flashes and sleep disruption, and there is some evidence that it helps with depression and aching joints. It also helps prevent and treat menopausal genitourinary syndrome, a collection of symptoms, including urinary-tract infections and pain during sex, that affect nearly half of postmenopausal women. It decreases the risk of diabetes and protects against osteoporosis.
Another article in the New York Times stated:
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.
With a long list of positive benefits, one must wonder why all the hate about hormone therapy. It appears that the only thing many physicians know about treating menopausal symptoms is what they’ve heard from the 2002 study. A survey from a few years ago found that many medical residents had not sat through a single lecture on hormone replacement therapy. More from the New York Times:
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.
My research design professor taught us there is no such thing as a so-called “smoking gun” study. What is required to prove causation is numerous studies approaching and testing a condition, all reaching a consensus over time. He claimed that there was something like 50,000 studies by 1995 that showed smoking was bad for your health. Yet, one study upended millions of women’s lives, and the bias persists to this day. More from New York Times:
… in 2002, a single study, its design imperfect, found links between hormone therapy and elevated health risks for women of all ages.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…
Another recent study, that just came out, again confirmed cardiovascular benefits from hormone replacement, but it’s likely that many physicians are still afraid to prescribe hormones. One study was all it took to change a therapy for a generation of women.
It wasn’t hormone replacement that caused the problems revealed in the 2002 study. It was synthetic, bio-non-identical hormone replacement. The FDA fought for years against the idea of bio-identical hormone replacement but eventually Pharma adopted it so it became OK for the FDA.