A Brief History of Hormone Replacement Therapy

An All-Too-Common Story Of Doctors And Others Ignoring Risks!

Starting in the 1960s, doctors began prescribing hormone replacement for postmenopausal women, claiming that it would help the women feel better, age more slowly, and reduce heart attack risk. Hormone replacement even was recommended for women who had no complaints of menopausal symptoms, on the grounds that it would protect the women against osteoporosis.

This practice continued for more than 20 years. It is easy to see why. Women want to feel better. Doctors want to enhance their perceived worth and build their practices based on prescribing medicines that seem to solve their patients’ problems. Pharmaceutical companies claimed that the therapy was safe. Hormone replacement seemed to be a good idea until it was actually tested.

Unfortunately, research revealed that hormone replacement was a big mistake. Evidence from large, long term studies finally showed beyond a shadow of a doubt that hormone replacement increased women’s risk of breast cancer, heart attack, and stroke, and caused a 200-400 percent increase in deep venous thrombosis and pulmonary embolism.3 If these increased risks were not bad enough, hormone replacement did nothing to reduce osteoporosis related fractures.4

This is a story repeated over and over in the history of medicine. Doctors and pharmaceutical companies have a long history of ignoring and underemphasizing the potential risks of drugs. Hence, drugs are used for years and then eventually are found to be too risky and lose favor.

Should hormone replacement therapy have been prescribed for 20 years—making billions of dollars for those promoting and selling it— without first having sufficient evidence that it would not cause harm? Why wasn’t hormone replacement therapy thoroughly tested for safety before physicians began pressuring women to take it? The problem is that there is no way to accurately discern risks unless millions of dollars are spent testing over many, many years with many thousands of people enrolled in studies. For example, it may take more than 10 years of use before a higher risk of breast cancer is observed. What we have to learn from this is that there are always risks when you fool too much with nature, and we must be cautious when using any type of drug or hormonal therapy.

References

1. Grady D, Wenger NK, Herrington D, et al. Postmenopausal hormone therapy increases risk for venous thromboembolic disease. The Heart and Estrogen/Progestin Replacement Study. Ann Int Med 2000;132:689-696.

2. Heiss G, Wallace R, Anderson GL, et al. Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA 2008;229(9):1036-1045.

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