The History Of Hormone Replacement Therapy (HRT)

by Marcelle Pick, OB-GYN NP

The history behind HRT and new alternatives, such as bioidentical hormones

What is hormone replacement therapy or HRT? Depending on the hormone levels in a woman’s body, HRT is the replacement or the balancing of hormones through various forms of therapy. Today, HRT is commonly referred to as HT or hormone therapy, which many people believe are two completely different conditions or forms of therapy.

For more than 6 decades, menopausal women have been treated with HRT, a synthetic or “nonhuman” hormone, with the intention of keeping women young and retaining their femininity. The very first brand of HRT in America, Premarin, was made up of conjugated equine (horse) estrogens (CEE). However, during the 1950’s, there was a growing concern over this form of treatment, as statistics showed an increase of uterine cancer in women who were using this form of therapy. Many years later, this finally prompted the drug company responsible for manufacturing Premarin, to develop Prempro by adding a synthetic progestin.

Over a period of time, doctors were trained that HRT prevented heart disease, kept women’s skin and brains youthful, built strong bones, and caused very few side effects. The majority of American women experiencing menopause were encouraged by their doctors to start some sort of hormone replacement therapy for their menopausal symptoms of hot flashes, mood swings, insomnia, and weight gain. It was considered malpractice if you did not prescribe HRT for menopausal women for years.

In the later part of the 1990’s, a number of women were questioning the use of HRT. Some of the common questions that arose were: “Did all women need it?” and “Why were all women put on the same dose and not different dosages?” and “What was actually happening to the pregnant mare whose urine was being used as part of Premarin or Prempro?” These women wanted to know if there was another alternative out there and available to them.

However, many women were convinced that HRT was beneficial and would not have considered the possibility of stopping treatment. In 2002, the results of an extensive women’s study (the WHI) looked at the effects of HRT (Premarin and Prempro — neither of which are bioidentical hormone forms), its findings overwhelmed the medical community. Establishing that HRT in fact did NOT decrease a woman’s chance of getting heart disease, but rather definitively increased her risk of blood clotting, stroke and breast cancer. As you can imagine, this was not the kind of news the medical community or patients wanted to hear.

Presently, the controversy continues as to whether the early findings were conclusive, particularly in relation to younger women who initiate HRT during perimenopause. Current research has indicated that that there are differences between the effects for a 50-year-old woman placed on HRT and a woman who begins ten or more years after menopause. Researchers have been reexamining the data from the WHI study to see if there is a subset of women who might benefit from replacement hormones, as well as identifying subsets who should avoid it. Every year, experts hotly debate the significance of each reanalysis — 2006, 2007, 2008 and 2009. At the present time, it is clear that there is a difference between those women that take hormones during menopause and those that are 10 years post menopause. The risks are definitely less for the menopausal woman.

Confusion escalated with the release of the 2002 WHI findings, and massive numbers of women stopped their HRT and began seeking alternative treatments to help them with their menopausal symptoms. Many of these women found that as soon as they stopped taking their HRT, their menopausal symptoms came rushing back. This was a huge disappointment for women who were struggling to deal with their symptoms but they were also afraid of the health risks of replacement hormones, particularly in the synthetic forms. Furthermore, the pharmaceutical companies argued that there were no good or viable alternatives to HRT.

Today, there are many natural methods available that can help women ease the transition off HRT while at the same time provide the body with the care it needs to reduce or avoid menopausal symptoms. For help during this transition period, see our articles about ending hormone replacement therapy.

Bioidentical hormones

Numerous women have turned to bioidentical hormones as a superior form of HRT. These are female hormones that are typically manufactured by our endocrine system, principally our ovaries — estrogen, progesterone, and testosterone — which naturally decline as the ovaries stop releasing eggs. By “bioidentical” we mean that the biochemical structure of the hormone is perfectly identical to the main hormones that are naturally produced in a woman’s body. Neither a horse’s hormone nor an artificially contrived formula, although similar in makeup, can replace what a woman produces naturally.

You may ask ‘Why did bioidentical hormones take so long to come into play?’ Pharmaceutical companies have had to create numerous nonhuman estrogens and progestins in order to patent their drugs, hoping that the small changes made to an estrogen or progesterone molecule would not have a negative impact on a woman’s body. Today, unfortunately, we know that is often not the case. Birth control pills are an example of synthetic estrogens and progestins, and, as any woman who has ever taken them can confirm, each brand has different side effects and there are in fact some women who cannot tolerate birth control pills at all. The same can be said with hormone replacement therapy — bioidentical or synthetic! As we are all different, what works for one may not work or another.

In the 1990’s, pharmaceutical companies started developing and patenting methods of administering bioidentical hormones. One example of this would be the Climara patch, which uses a sticky transdermal hormone delivery system. While Climara was patented in 1994, the estrogen, which is identical to human estradiol, cannot be patented. The patent was obtained by patenting the glue.

Moving into the future of HRT

There are professionals who believe that true bioidentical hormones can only be developed by a compounding pharmacy, and only after measuring a woman’s own hormone levels, and then customizing the dose. In our experience, this approach is only required in a few cases or for a short period in a women’s life. In any case, Mother Nature provides a woman’s body with numerous types of hormones and we cannot accurately reproduce her delivery methods or levels in the body. What we can do is estimate her methods and work alongside her. We can also observe a woman’s symptoms and see if the right prescription has been developed. By helping to implement a good nutritional regime and supplements, appropriate exercise and other lifestyle changes, we have found that many women can manage their menopause symptoms very well!

There are times, however, when a woman can significantly benefit from a small amount of hormone replacement. We always recommend that you, together with your doctor, work through the challenges of menopause, especially if you have severe menopause symptoms, early menopause, or if you are compromising on your quality of life. It is under these circumstances that you will be able to make an informed decision about bioidentical hormones.