Hormones were unknown to Shakespeare, but the chemical messengers controlled significant bodily functions in his day and long before. Even though he was unaware of their influence on the body, he knew that making fun of something that hurts someone else is not funny.
In Romeo and Juliet, he said, “He laughs at scars who never felt a wound.” In the early 1900s, about 300 years after Shakespeare died, researchers discovered hormones, according to the National Institutes of Health (NIH). Anyone who has experienced a hot flash knows that it is not funny. Hormone replacement therapy originated to alleviate one of the most dreaded symptoms of menopause.
Reviewing the History of Hormone Replacement Therapy (HRT)
Hormone replacement therapy balances hormone levels in the female body. For about 50 years, women received treatment for menopausal symptoms with a synthetic hormone. However, concerns developed during the 1950s about the side effects of using synthetic drugs for HRT. Statistical evidence indicated that women who used the therapy experienced an increase in uterine cancer. Manufacturers modified the product by changing the formula.
Recognizing Changes in Recommendations
In the ensuing years, doctors held the opinion that the effects of HRT were beneficial to women by preventing heart disease, building strong bones and keeping skin supple while controlling menopausal symptoms. By the 1990s, women began to question the uniformity of doctors’ recommendations for HRT and started seeking an alternative treatment.
Addressing Safety Concerns
In 1991, NIH created the Women’s Health Initiative to examine preventive measures for some health issues of postmenopausal women. Of specific interest were the causes of disability, death and impaired quality of life. The 15-year study employed a scientific method to identify factors that predicted disease among healthy postmenopausal women.
Clinical trials measured participants’ reactions to postmenopausal hormone therapy, dietary modification, and the effects of vitamin D as well as calcium supplements on breast and colorectal cancer, heart disease and bone fractures. The clinical trial for hormone replacement included one study of estrogen plus progestin for women who had a uterus and another study of estrogen alone for women without a uterus. The WHI findings on hormone therapy indicated that the number of prescriptions diminished significantly.
Reviewing the Findings of WHI
Medscape reports that a key finding in the WHI study was the reduction of 37 percent in colon cancer for HRT users. The incidence of hip fractures decreased by 34 percent. However, an increase of 26 percent in the occurrence of invasive breast cancer stopped the work of WHI. Compounding the negative findings was a 41 percent increase in the occurrence of strokes and a 29 percent increase in heart attacks.
Understanding the Conclusions of the Findings
The Cleveland Clinic summarizes the findings in this way:
- The estrogen plus progestin combo does not provide protection from heart disease in women who are several years past menopause.
- The risks of breast cancer, stroke and heart attack outweigh the benefits of fewer incidents of colon cancer and hip fractures for women who had no reason to take HRT other than prevention.
Comparing Health Risks and Health Benefits
For risks, there was a measurable increase in cancer, heart attack and stroke. An increase in breast cancer in 38 women out of every 10,000 taking estrogen plus progestin occurred, as opposed to 30 who were in a control group for the study. Similar results occurred for heart attacks (37 to 30) and strokes (29 to 21).
For health benefits, the results showed reductions in colon cancer and hip fractures. Estrogen plus progestin reduced total cholesterol and bad cholesterol (LDL) while increasing good cholesterol (HDL). Women on HRT had fewer hip fractures than those in the control group (10 to 15), and 10 developed cancer of the colon as opposed to 15 in the control group.
Understanding the Requirements for Using HRT
Health Grades offers guidance for considering the use of HRT. The occurrence of severe menopausal symptoms that diminish the quality of life is a requirement that may justify the use of HRT. Conditions such as problems sleeping, night sweats, headaches and painful intercourse are indicators of symptoms that are severe.
- The early onset of menopause that starts before the age of 40 is an indicator of the potential need for HRT.
- A family history of colon cancer or osteoporosis is a probable requirement for the treatment.
- Entering menopause before the age of 45 as a result of having radiation or chemotherapy is a qualifying factor worth considering.
- Onset of menopause before the age of 45 as a consequence of the removal of ovaries may qualify as a requirement for HRT.
- Failure of other treatment strategies may indicate the need for choosing HRT.
Reasons not to use HRT include mild menopausal symptoms and a family history of breast cancer or heart disease. Having no risk of osteoporosis decreases the reasons to use it, and cardiac concerns preclude it.