The Rise of Hormone Replacement Therapy

In 1963, Brooklyn gynecologist Robert A. Wilson and his wife, Thelma, published a paper in the Journal of the American Geriatrics Society arguing that untreated menopause robbed women of their femininity and ruined the quality of their lives. Wilson went on to publish a best-selling book in 1966, titled, “Feminine Forever,” in which he maintained that menopause was an estrogen-deficiency disease that should be treated with estrogen replacement therapy to prevent the otherwise inevitable “living decay.” In the book, Wilson warned that unless women began taking estrogen replacement every day for the rest of their lives, they were doomed to become “dull and unattractive crones that husbands would find difficult to live with.” Despite a lack of research to back up his claims, women and their doctors were persuaded that Hormone Replacement Therapy (HRT) was the cure to the “living decay” of menopause. Millions of women were started on HRT – a trend that would continue for the next few decades.

By the early 2000s, perceptions of Hormone Replacement Therapy began to change. In 2002, the Women’s Health Initiative (WHI) revealed that Prempro, the most trusted brand of HRT used in the study and by millions of menopausal women at the time, could no longer be trusted. Prempro refers to a combination of Premarin, estrogens derived from the urine of pregnant mares, and Provera, a synthetic progestin. WHI investigators discovered that it was, in fact, putting women at risk for the diseases of aging they’d been promised it would protect them against. Millions of menopausal women stopped using HRT overnight.

The Fall of HRT 

In the wake of the WHI revelations, many women found themselves out in the cold, not knowing which way to turn for relief from severe menopausal symptoms. Providers were caught between a rock and a hard place: if they continued to recommend synthetic forms of Hormone Replacement Therapy in the “one-size-fits-all” doses they were trained to prescribe, they’d be putting their patients at risk. But not prescribing anything meant that many women went untreated for severe menopausal symptoms. 

The pendulum of HRT swung fully in the other direction, leaving many clinicians without any HRT experience. “Many, many clinicians no longer prescribe hormones, or know how to prescribe,” says Dr. JoAnn Manson, director of the North American Menopause Society (NAMS), and one of the WHI’s lead investigators. Dr. Manson went on to explain, “this isn’t a good situation for women who are having severe menopausal symptoms; these patients are going to have trouble finding clinicians who can help them make the most informed decisions.” 

So, what’s happened with Hormone Replacement Therapy since the early 2000s? 

Hormone Replacement Therapy in Las Vegas Today

Today, HRT has found a place in the middle. The good news is, HRT is getting the research it always deserved. The better news, research is beginning to find HRT can be effective at treating certain types of cancer and other hormone-related conditions. Of course, research has found risks associated with HRT, but many of these risks can be mitigated by changing the dose of estrogen and/or the synthetic hormone. Further, for women who reach menopause prematurely, the protective benefits of HRT can outweigh the risks. Your age, type of menopause, symptoms, and family history all play an important role in determining the risks and benefits of HRT for you. 

What we’ve learned from the Pendulum of HRT, and the subsequent research, is that there is no one-size-fits-all approach to hormones and women. Every body is different, and every woman experiencing severe menopausal symptoms may react differently to the same HRT treatment. The best way to provide support and treatment for patients in need of HRT is to customize a therapy that works for them. 

As researchers learn more about hormone replacement therapy and other menopausal treatments, HRT recommendations may vary. If you have bothersome menopausal symptoms that won’t go away, make an appointment with Galleria Women’s Health, and together we can review the best options for you and your body. Click here to learn more about hormones.