Why Is Hormone Replacement Therapy So Controversial?

Every year, about two million women enter menopause. While some women sail through with minimal trouble, many if not most suffer with hot flashes, night sweats and other symptoms. Doctors may offer them hormone replacement therapy, but this treatment is still extremely controversial.

Hormone Replacement Therapy for Menopause:

Q. I have been on Premarin for 26 years with no problems whatsoever. Without it, I prayed to die because of the horrendous effects of menopause.

I am also on two compounded products, testosterone/DHEA cream and progesterone cream. Based on my own experience, I believe all women should take advantage of hormone replacement for longevity and a good healthy life after menopause. I look and feel great at my age of 69 years.

History of the Controversy:

A. Until 2002, many doctors thought that most postmenopausal women should be taking estrogen. (Women who still had a uterus were also supposed to take progesterone to prevent endometrial cancer.) They believed that hormone replacement therapy (HRT) would prevent chronic diseases, especially heart attacks, strokes, osteoporosis and even Alzheimer’s disease.

Then, fifteen years ago, the results of the Women’s Health Initiative were published (Rossouw et al, JAMA, July 17, 2002).  This randomized controlled trial showed that “Overall health risks exceeded benefits” when estrogen and progesterone (Prempro) for five years was compared to placebo. Another group of women took Premarin alone or placebo for seven years.

What the WHI Showed:

Women on HRT had a higher risk of strokes and breast cancer (Manson et al, JAMA, Oct.2, 2013). During the five-year duration of the study, however, there was no difference in mortality between women taking HRT and those taking placebo. A recent report shows that after 18 years the participants still have no significant differences in mortality (Manson et al, JAMA, Sep. 12, 2017).

Women like you who suffer during menopause often feel more comfortable taking estrogen (and progesterone, if indicated) during the time they need to suppress hot flashes. Experts usually recommend the lowest effective dose for the shortest possible time. In most cases, that would be considerably less than 26 years.

Other Objections to Premarin:

Some women object to Premarin and Prempro on ethical grounds. Premarin is made from pregnant mares’ urine. Many people worry that keeping the horses pregnant and confined constitutes inhumane treatment. Doctors can prescribe other forms of HRT such as estradiol. Consequently, women who object to Premarin should request an alternative.