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July Newsletter: The Truth About Hormone Replacement Therapy

by the National Women's Health Network

The widespread popularity of hormone replacement therapy in the United States is a triumph of marketing over science and advertising over common sense. As a society, we ignore the fact that menopause is not a disease. It is a normal transition that occurs in all women.

Many consumers (and their health care providers!) honestly believe that hormone replacement therapy (HRT, the use of estrogen together with progestogen) or estrogen replacement therapy (ERT, the use of estrogen alone) prevents a variety of serious diseases and helps women look younger.

Despite this belief, there is no valid scientific evidence that estrogen prevents heart disease, colon cancer, Alzheimer's disease, or wrinkles. What the evidence does show is that estrogen reduces some symptoms of the menopause transition. Women should be aware that there are other choices for dealing with these symptoms.

No randomized, placebo-controlled trial to date has shown that hormones prevent heart disease. Claims to the contrary are based on old, scientifically flawed observational studies whose results cannot be trusted. This is why the Food and Drug Administration (FDA) has never approved any form of estrogen for heart disease prevention. [1]

What's more, evidence gathered from studies on the benefits of HRT in preventing colon cancer, Alzheimer's, and wrinkles is inconclusive and conflicting. In the past few years, for example, several studies reported that women taking ERT and HRT were less likely to develop or die from colon cancer.[2] However, like other supposed benefits claimed in observational studies, the fact that healthier women chose to take hormones in the first place may account for the apparent risk reduction.

As for osteoporosis, there is good evidence that estrogen delays bone loss for as long as a woman takes it, but the evidence that it reduces fractures when they are most likely to happen - around age eighty - is weak. In fact, studies show that taking measures to prevent falls lowers fracture risk far more than any drug can. Unfortunately, this fact does not stop the osteoporosis industry from exaggerating the likelihood of fractures and disability and bombarding consumers with advertisements for HRT and ERT.

Confusing the picture even more is a new category of drugs known as Selective Estrogen Receptor Modulators (SERMs). These drugs are the "designer estrogens" we frequently hear about. SERMs purportedly give us the alleged benefits of hormone therapy without the risks. However, the long-term safety and efficacy of these drugs has not been demonstrated.

When is HRT a Good Idea?

Scientific evidence supports the use of HRT only in the following cases:

  • for women who have had both ovaries surgically removed at an early age
  • for women with severe hot flashes, night sweats, or vaginal dryness
  • as one option for maintaining bone density in women at high risk of osteoporosis

For women who experience troublesome hot flashes or vaginal dryness, we recommend they try nonhormonal therapies as the first line of treatment. Later, if a woman chooses hormones, we suggest she take the lowest dose for as short a time as possible.

There really is no easy answer to the conundrum should I or shouldn't I take hormones. However, women need to know that scientific evidence does not support routine use of hormones in menopausal or perimenopausal women. What's more, it is poor public health practice to attempt to prevent chronic diseases by recommending drugs of unknown efficacy and known adverse effects to an entire population, when lifestyle measures or other therapies may achieve the same or better benefits.

One simple remedy is exercise. Regular exercise protects bones, reduces the risk of falls, reduces the risk of heart disease, and increases the sense of well-being. Except for an occasional strain or sprain, sensible, regular exercise has no negative side effects.

Many women who go ahead and use HRT experience higher rates of blood clots and possibly breast cancer. They are more likely to undergo hysterectomies or have their gallbladders removed. Taking hormones also makes mammograms more difficult to read so that HRT users are more likely to get false mammogram readings and miss the diagnosis of breast cancer in its earliest, most treatable stage.

HRT Has Not Been Shown To
  • Prevent wrinkles or other natural signs of aging
  • Cure urinary incontinence
  • Help moodiness or depression
  • Improve sexual desire or responsiveness
  • Prevent heart disease
  • Improve memory
  • Prevent Alzheimer's disease

The Bottom Line

To us, the bottom line is clear. Some health care providers who have not done their homework are pressuring women to take hormones up to five years before menopause on the theory that hormones support bone health, a notion unsupported by scientific fact. The popular media have jumped on the bandwagon and are urging menopausal women to begin taking hormones as soon as possible.

Both groups make it sound as though the cessation of normal menstrual cycles does lasting harm to the body within days or weeks of its onset. The truth is that it doesn't. Most women have months or years to make decisions about whether or not hormones make sense for them and to reevaluate their decisions as their situations change or as new scientific information becomes available.

It's also important to understand that the risk-benefit calculation for individual women is different at different ages. For most women who start HRT at menopause, the risks come at younger ages, while the benefits emerge much later in life.

On behalf of the entire National Women's Health Network, we urge you to take all the time you need to make an informed decision about starting or continuing hormones. Read our book, The Truth About Hormone Replacement Therapy, paying particular attention to the studies listed in chapter 14. Also, talk to your health care provider and think about all the issues involved until you feel you know the truth about HRT.

We hope that our book will serve as a sensible guide to help you make the best possible decision for you.

Cynthia Pearson
Adriane Fugh-Berman, MD
Amy Allina
Charlea Massion, MD
Mariamne Whatley, PhD
Nancy Worcester, PhD
Jane Zones, PhD
Ellen Michaud

The National Women's Health Network is a group of 10,000 women, consisting of physicians, health care professionals, and concerned members who advocate for women's health. The NWHN is a non-profit organization and acts as an independent voice for women's health and thus accepts no money from companies that sell pharmaceuticals, medical devices, dietary supplements, alcohol, tobacco, or health insurance.

This excerpt was reprinted from The Truth About Hormone Replacement Therapy: How to Break Free from the Medical Myths of Menopause by the National Women's Health Network. Published by Prima Publishing, a division of Random House, 2002. For information on to how to purchase this book please contact the Random House Order Department: 1800-733-3000 or visit the NWHN website:

This article first appeared in A Friend Indeed, the newsletter for women in menopause and midlife.


[1] For more information, see chapter 14 "The Studies," and appendix A of The Truth About Hormone Replacement Therapy (Prima Publishing, 2002).

[2] Calle EE, et al. Estrogen replacement therapy and risk of fatal colon cancer in a prospective cohort of postmenopausal women. J Natl Cancer Inst 87(7): 517-523, 1995; Newcomb PA, Storer BE. Postmenopausal hormone use and risk of large-bowel cancer. J Natl Cancer Inst 87(14): 1067-1071, 1995; Grodstein F, et al. Postmenopausal hormone use and risk for colorectal cancer and adenoma. Ann Intern Med 128(9): 705-712, 1998.

Contact Sue Richards at [email protected]

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