Premature Menopause - What Is Menopause: Menopause

The rise and fall of hormone therapy

Recent decades have been a roller coaster ride for women on menopausal hormone therapy — long called hormone replacement therapy, or HRT. The number of women taking estrogen at menopause rose during the 1960s, when this treatment was touted as a virtual cure-all for women's midlife woes. Premarin, the oldest prescription hormone replacement drug, is a mixture of estrogens derived from the urine of pregnant mares (hence the name, Pre-mar-in). Taken in pill form, the drug was prescribed to replace women's "missing" estrogen and relieve menopausal complaints. Estrogen was later found to help combat osteoporosis, a common, disabling bone disease among elderly women. Subsequent research suggested that estrogen therapy might also lower the risk of heart disease, the nation's leading cause of death in postmenopausal women.

By the early 1990s, Premarin was the most widely prescribed drug in the United States. Millions of women who had not undergone hysterectomy were also taking progestogen, which helped counteract the increased risk of uterine cancer found among estrogen users. Although the annoying symptoms of menopause typically fade after a few years, many women stayed on hormones for far longer, sometimes for decades. In fact, many doctors encouraged women to keep refilling their prescriptions, since the prevailing wisdom was that long-term HRT helped fend off osteoporosis and heart disease.

But by the late 1990s, evidence from several studies had cast doubt on the heart-protecting benefits of hormones. And in 2002, after new evidence from a major, long-term research study demonstrated that Prempro (a combination of estrogen and progestogen) slightly increased the risk of heart disease, stroke, serious blood clots, and breast cancer, a minor revolution ensued (see "The hormone studies: The Women's Health Initiative"). Throughout the nation, an estimated 6 million women who were currently taking hormones were urged to discuss the situation with their clinicians. Many doctors advised their patients to stop taking the drugs, and hormone prescriptions dropped dramatically. Hormone therapy, as it's now called, is no longer routine treatment for menopausal women.