For decades doctors have been pushing women to take hormone replacement therapy. That’s why drugs like Premarin, Provera and Prempro were among the most popular prescription pills in the pharmacy.
Premarin was approved in 1942, but it really got attention in 1966 with the publication of the book “Feminine Forever.” Dr. Robert Wilson championed the use of estrogen for a wide range of “female problems.” Although this Manhattan gynecologist received financial support from the maker of Premarin, most doctors and patients probably did not know about that relationship.
Dr. Wilson promoted estrogen for its ability to keep “a woman sexually attractive and potent.” He also claimed it protected the heart, brain, and kidneys and preserved “the strength of her bones, the glow of her skin, the gloss of her hair.” He also maintained that fears of cancer were misguided and claimed that estrogen actually prevented cancer.
By the late 1970s, doctors had discovered that women on estrogen were far more likely to develop cancer of the uterine lining. Sales of Premarin took a nose dive until a decade later, when physicians found that adding progesterone to the regimen seemed to protect the uterus.
Sales doubled between 1990 and 1993 and continued to climb throughout that decade. Doctors reassured women that fears about breast cancer were overblown and that products like Prempro (estrogen plus progestin) would protect the heart.
As an added bonus, they suggested that hormone replacement therapy might prevent mental decline or even Alzheimer’s disease. Premarin became the most prescribed drug in America.
Last year, though, hormone replacement therapy crashed and burned. Researchers with the Women’s Health Initiative, the largest independent study to collect data on HRT, concluded that Prempro actually increased women’s risk of heart disease and blood clots as well as breast cancer. That part of the study was ended prematurely because the results were so disappointing.
Now a new revelation has put another nail in the coffin. Three articles in the Journal of the American Medical Association (May 28, 2003) demonstrate that hormone replacement therapy does not protect women from mental decline, Alzheimer’s disease or stroke. If anything, Prempro made women more vulnerable to strokes and doubled their risk of dementia.
How could so many physicians be misled for so long? Starting with Dr. Robert Wilson back in 1966, many doctors have been persuasive cheerleaders for this therapy. Even though the data were incomplete, drug company promotion convinced most physicians that menopausal women needed HRT.
For an overview of this controversial issue you may wish to read our Guide to Estrogen: Benefits, Risks and Interactions. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (60 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. W-49, P. O. Box 52027, Durham, NC 27717-2027.
Does this mean that women should avoid HRT? For some, it is the only way to relieve unbearable hot flashes and night sweats that disrupt sleep. For others, the risks outweigh any benefits. As always, the decision about HRT must be made by each woman in consultation with her doctor.