(Before we begin this rather controversial topic, please keep in mind that this is not intended to be used as medical advice. Anything we discuss over the next several weeks should be considered a topic to explore with your PCP, not recommendations to begin a new treatment.)
Let’s start with why a woman would need estrogen replacement therapy. In general, between the ages of 45-55 a woman’s estrogen level will drastically decline. During this time, she may experience mood changes, weight gain, sleep disturbances, vaginal dryness and hot flashes. Not all women experience menopause the same. Some may feel only mild symptoms, while for others it can seem unbearable. It is for this latter group that hormone replacement therapy would typically be considered.
In 1942, the FDA approved Premarin for relief of hot flashes. By the 1960’s, it was so effective for hot flash prevention that Premarin’s popularity was gaining with almost 40% of menopausal or perimenopausal being on hormone therapy. (This is compared with less than 10% of women being on hormone replacement currently, even if clinically indicated but more on this later.) Doctor’s began using Premarin for everything from heart protection to fracture prevention.
In 1993 The Women’s Health Initiative (WHI) was launched. It constituted a billion dollar, 20 year study with 161,808 women participating, aged 50-79. The goals were to evaluate for the effects of estrogen on cardiovascular health and fracture risk reduction. The study was stopped early due to alleged findings of increased risk breast cancer, heart disease and stroke.
This sounds like an open and shut case for estrogen. It is clearly bad, right? Well, no..and this is where it gets tricky. The interpreted data collected from the WHI was flawed. 1) Women experiencing menopausal symptoms were excluded from the trial. 2) The date collected was not allowed to be reviewed by investigators before being rushed to publication 3) Only 32% of the women in the study would be in the appropriate age range to receive any benefit (more on this later) while 70% of the women had likely been through menopause more than 10 years ago and thereby not making the results applicable to the average menopause aged women. 4) Furthermore, it should be noted that most of the women in the study were obese and at least 50% were cigarette smokers.
I know that this is a little dry so far, but I did need to provide some context before our next segment. If you are curious about hormone replacement therapy stay tuned for next week’s blog discussing the pros and cons of estrogen therapy.
- Brooke Rieth NP
