The Hormone Replacement Therapy Controversy

By Elizabeth Lee Vliet, MD
Excerpted and condensed from It’s My Ovaries, Stupid, Author’s Note

Hormones—and their connections in how we think and function—have been my life’s work. The summer of 2002 brought a maelstrom of negative, frightening headlines abput “hormones” and hormone replacement therapy. The headlines screamed that estrogen increase the risk of breast cancer. The newsmakers said hormone replacement therapy causes heart attacks and strokes, not prevents them.

Women are now afraid to consider birth control pills or menopause hormone therapy. We are made to feel terrified about hormones our bodies make naturally our entire reproductive life.

Why suddenly such intense negative focus on estrogen? What is really going on here?

Negative reports from the Women’s Health initiative (WHI) and Heart and Estrogen/progestin Replacement Study (HERS) hit the media like a nuclear explosion in the summer of 2002. Each of these clinical trials used only one form of estrogen—Premarin—derived from the urine of horses, and a synthetic progestin—Provera—both hormones not at all identical to anything our bodies ever made naturally, a point rarely mentioned in the coverage. There are many well-studied, alternative, bioidentical (or “natural” forms of hormones available, with fewer negative side effects.

Why don’t we get a full picture of the studies? Why are the negative results trumpeted and crucial positive findings downplayed or ignored? The press shouted that there was a 26% increase in risk of breast cancer. What they didn’t say was that statistical increase was minute. The alarmist headlines made it appear that more women died taking hormones. This was not so.

The focus on fear of breast cancer appears to sell newspapers and magazines. That same fear is used to sell everything from herbs and soy supplements to new and expensive “designer estrogen” prescription products. Instead of educating women with balanced information, we are bombarded with poorly researched and hastily presented stories with a biased focus on breast cancer to the exclusion of other disorders that kill many times more women every year.

We must strip away the myths surrounding hormones and hormone therapy, including such misconceptions as “Hormones cause cancer,” “All estrogens are the same,” “All progestins are the same,” and “How you take hormones doesn’t matter.”

• Women need straight talk, sound information, and more of the complete story behind the headlines.
• Environmental endocrine disruptors interfere with the function and production of human hormones and increase cancer risk. We need to recognize and research, expose and identify these hormone saboteurs and toxins that are often ignored.
• The cookie-cutter approach cannot continue. One form of estrogen derived from pregnant horse’s urine has been used for about 85% of all hormone replacement therapy prescriptions—despite the fact that bioidentical hormones have been available since 1976.
• Bioidentical human forms of hormone products need to be used instead of horse-derived or synthetic progestins that have very different and often negative effects on the human body.
• “One size fits all” is no longer acceptable. Women are individuals, with individual body chemistries. Women vary in response to hormones just as they do to other classes of medicines (and herbs). Women must have hormone options individually tailored to their needs.
• We must measure hormones with objective tests. The “gold standard” serum (blood) tests for hormone levels are reliable for management of infertility in younger women. We must apply these same tests for management of midlife and menopausal hormone issues. Saliva tests and hair analysis simply are not adequate for the complexity of women’s issues.