Businesswoman in Menopause fanning herself, HRT, hormone replacement therapy

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.

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  1. April

    Think this sight is excellent at providing practical self care information, that does no harm.

    Think you are way out of your league and not current on the emerging/new knowledge of human female, at mid-life, physiology. An encyclopedic command of the research and the abysmal history of estrogen hormone replacement is paramount to give women correct & safe advice. My two posts of Oct 3 and 7 where I cite the science are “awaiting moderation”. This is sad as women might want to know what kind of suffering, misery and harm can be involved with HRT.

  2. Incredibly frustrated

    I have over 16 years, possibly more till I can retire. I need to be able to continue working. I really wish that holding a cold washcloth to my head would be enough. I have severe hot flashes, I have a job where I’m extremely physically active in the heat, and the hot flashes make me feel like vomiting, and blacking out. If I do black out and hit my head, I risk a permanant traumatic brain Injury. I’ve already fell and suffered post concussive syndrome for over a year. My menopause symptoms are not annoying, they’re potentially life threatening. Memory issues, UTI’s, problems with urgency, bladder issues, vaginal atrophy. I have a list as long as my arm and can only get the Dr to perscribe an estradiol vaginal ring with a 200$ copay every 3 months. I’m ready to try anything but Premarin. For some women this it’s not a lifestyle drug.

  3. Terri

    I am interested in learning more about the cognitive benefits, if any, of using HRT post-menopause. If there are demonstrated benefits, is there a window when HRT must be started in order to be effective and is there a specific length of time that it should be continued?

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