The Ugly Truth About Hormone Replacement Therapy

Hormone replacement therapy for menopause can increase women's risk of cancer and other problems. Learn why you should avoid these treatments and how to treat menopause naturally.

What Is Menstruation And Menopause?

Menstruation is the monthly shedding of the lining of a woman's uterus. Menses, menstrual period, menstrual cycle, or period are also known as menstruation. 

Menstrual blood is partly blood and tissue inside a woman's uterus. It flows from the uterus through the cervix and out of the body through the vagina.

The menstrual cycle is when the body prepares for a possible pregnancy each month. It is from the first day of the period until the first day of the next period. Every woman's cycle is slightly different, but the process is the same.

The average length of a menstrual cycle is 28 days. However, a cycle can range from 21 to 35 days and still be normal.

Hormones drive menstruation. They are chemical messengers in women. The pituitary gland and ovaries make and release hormones during the menstrual cycle.

These hormones cause the lining of the uterus to thicken. This process happens so an egg can enter the uterine lining if a pregnancy occurs. 

Hormones' Role In Pregnancy

Hormones cause ovaries to release an egg through ovulation. The egg moves down the fallopian tubes, where it waits for sperm. If a sperm doesn't fertilize that egg, pregnancy doesn't occur. 

Women's hormones play a role in many body functions. Progesterone and estrogen are important ones.

Estrogen is part of many body functions. It thickens the uterus lining, and prepare women for pregnancy. Estrogen maintains healthy blood cholesterol levels and keeps the vagina healthy. It also helps prevent bone loss.

Progesterone prepares the uterus to implant a fertilized egg. It helps women maintain their pregnancy. Progesterone also regulates blood pressure in women and improves their mood and sleep.

Everything comes to an end, even women's menstruation.

What Is Menopause?

When women age, they will experience menopause. Menopause is 12 months after a woman's last period. Women may have changes in their monthly cycles.

The menopausal transition most often begins between ages 45 and 55. It lasts about seven years but can stay as long as 14. The duration can depend on lifestyle factors such as smoking, age, race, and ethnicity.

Menopause affects each woman in different ways. Women's fat cells change, and they may gain more weight. They can experience bone, heart, body shape, and physical function changes.

A hysterectomy, or surgical removal of the ovaries, can also cause menopause. After menopause, women enter postmenopause. Postmenopausal women are more vulnerable to heart disease and osteoporosis. Osteoporosis is when your bones become fragile and break.

But it doesn't end there. There are other symptoms you can experience during menopause.

Common Symptoms Of Menopause

Many parts of a woman's body use estrogen. Various symptoms occur when estrogen decreases. Many women experience mild symptoms. Most of them disappear with lifestyle changes such as avoiding caffeine. 

Some women don't need any treatment at all, but for others, symptoms can be more severe. The severity of symptoms varies worldwide and by race and ethnicity.

Some women have hot flashes, which can last for many years after menopause. They may be due to changing estrogen levels. A hot flash is a sudden feeling of heat in the upper part of the body. 

Your face and neck may become hot. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow. 

Hot flashes can be mild or strong enough to cause night sweats. Most hot flashes last between 30 seconds and 10 minutes. They can happen several times an hour, a few times a day, or once or twice a week. 

Incontinence is a loss of bladder control. You may have a sudden urge to urinate, or urine may leak during exercise, sneezing, or laughing. 

Another symptom of menopause is a lack of sleep.

Menopause Can Lead To Sleep Loss, Obesity, And Pain

Some women may have trouble getting a good night's sleep. They can't fall asleep or wake up too early. Night sweats might wake them up. 

After menopause, the vagina may become drier, which can make sex uncomfortable. Women might feel moodier or more irritable around the time of menopause.

Their waist could get larger and make them lose muscle and gain fat. Women's skin could become thinner. They might have memory problems, and joints and muscles could feel stiff and painful.

Some women's symptoms may include aches and pains, headaches, and heart palpitations. Perimenopause is in the months or years leading up to menopause. During that time, women might experience these symptoms:

Many women treat these symptoms with hormones. Let's look at these treatments and why they are not a great idea.

What Is Hormone Replacement Therapy(HRT)?

Hormone replacement therapy(HRT) is the most common treatment for menopause symptoms. It boosts women's hormone levels. HRT may relieve some of the symptoms of menopause. 

Other names for HRT are hormone therapy, menopausal hormone therapy, and estrogen replacement therapy. 

There are two main types of hormone replacement therapy. Estrogen therapy is when doctors prescribe a low dose of estrogen as a pill or patch every day. You can also get estrogen as a cream, vaginal ring, gel, or spray. 

Let's learn more about these products.

How Pills, Creams, Gels, Or Sprays Help Symptoms

Pills are the most common treatment for menopause. An estrogen patch is something you wear on the skin of your abdomen. Some patches last every few days, while others work for a week. 

Vaginal estrogen comes in a cream, vaginal ring, or vaginal estrogen tablets. These treatments are for women with vaginal dryness, itchiness, or pain during intercourse.

Creams, gels, and sprays offer other ways of getting estrogen into your system. The body absorbs estrogen through the skin into the bloodstream. 

Dosing schedules vary, depending on the product. You need to replace vaginal rings every three months. Vaginal tablets are often used daily for a couple of weeks. 

After that, you only need to use them twice a week. You can use creams daily, several times a week, or according to a different schedule.

Some treatments also combine estrogen and progestin.

Estrogen And Progestin Hormone Therapy

Estrogen/Progesterone/Progestin Hormone Therapy is often called combination therapy. It combines doses of estrogen and progestin, the synthetic form of progesterone.

This therapy is meant for women who still have their uterus. Progesterone can help treat menopausal symptoms such as hot flashes.

HRT may:

It can also have adverse effects such as:

The medical establishment has turned a natural process into a disease. Women learned that they needed to treat menopause issues with drugs.

How The Medical Establishment Turned A Natural Process Into A Disease

Doctors have told millions of women over the last decades to take HRT. Researchers, newspapers, and magazine articles all told the same story. They said HRT would protect postmenopausal women and improve their lives. 

Hormone pills became the top-selling drugs for several years. But then the truth came out. HRT didn't decrease the risk of heart disease, strokes, or Alzheimer's disease. It increased these risks. 

Estrogen production does not stop after menopause. The cells produce about one-tenth as much estrogen after menopause. Estrogen levels fluctuate as the body adjusts to its new life. 

The body responds to fluctuating levels of estrogen in the blood. A minority of women have menopausal symptoms that are severe and need therapy. 

Only one out of six women going through menopause experiences severe hot flashes. Few have serious night sweats or bothersome vaginal dryness. 

Half of the women going through menopause have no hot flashes at all. Symptoms usually last no more than two to five years. Only one out of 20 women has troublesome symptoms that persist long after menopause. 

Despite this fact, doctors pushed women to take HRT treatments. The most popular HRT therapy comes from horses.

The Most Popular HRT Treatment Comes From Horses

The company Wyeth-Ayerst created Premarin, a brand name for estrogen. Premarin comes from Pregnant Mares Urine. During pregnancy, mares(female horses) increase estrogen production by several hundredfold. Premarin uses that urine in their formula.

Horse estrogen is like human estrogen. Each mare produces enough estrogen to treat about 150 women. The FDA approved Premarin in 1942 for menopause symptoms.

In 1962, Dr. Robert Wilson published an article in JAMA. He was a gynecologist who reported the results of a study with 304 women treated with estrogen. None of the participants developed cancer. Wilson concluded that hormone pills prevented breast and genital cancer.

In 1966, he published his best-selling book, Feminine Forever. He told readers that untreated menopause could lead to a host of problems. Menopause was the rapid decline in appearance, sexuality, health, and quality of life. 

Not surprisingly, Wilson got money from drug companies to push for HRT treatments.

A Doctor Who Told Women To Take HRT Had Financial Ties To Drug Companies

Wilson's foundation received money from several drug companies, including the manufacturer of Premarin. In 1965, the Wilson Research Foundation received $34,000 from drug companies. 

In total, Wilson's foundation received $1.3 million from drug companies. Later, he co-wrote an article with his wife, Thelma, in 1972. She was a registered nurse. The Wilsons described female aging as a disease. 

It was the failure of postmenopausal women's ovaries to produce estrogen. They believed women could treat it with estrogen like we do with the pancreas with insulin.

Premarin became the most prescribed brand-name drug in the United States in 1966. It remained one of the five most popular prescribed drugs through 1975. 

Wilson's book promoted the use of estrogen for women who had reached menopause. Hundreds of newspaper and magazine articles spread the same message. 

However, there were some controversies with estrogen treatments.

Estrogen Treatment Cancer Controversies

In December 1975, two articles in NEJM showed that estrogen increased endometrial cancer. It is a cancer that begins in the uterus. Endometrial cancer went up 14-fold after seven years of estrogen treatment.

In 1979, a Lancet article said that adding progestin lowered the cancer risk. Several other studies soon confirmed the same thing. HRT sales still plummeted. Doctors only filled half as many prescriptions for Premarin in 1980 than in 1975. 

Drug companies had to find another way for women to use HRT treatments. They needed to unveil a disease to market their drug.

Then they found one.

The Perfect Disease To Increase HRT Treatments

Osteoporosis was a perfect disease to sell HRT treatments. It is a disease that thins and weakens the bones. There are no symptoms until you develop fractures. No postmenopausal woman could be sure she was safe. 

The criteria made sure that 1/4 of all women over 65, or more than half of women over 75, could have the disease.

Drug companies placed ads in medical journals showing wheelchairs and crooked spines. They funded medical meetings and lectures about osteoporosis.

The next step was to mislead the public. In 1985, only 23% of women had heard of osteoporosis. Burson-Marsteller was the public relations firm hired by Wyeth-Ayerst. 

Their campaign was successful in increasing public concern about osteoporosis. It generated many articles in women's magazines. 

The National Osteoporosis Foundation started with drug company support in 1986. Doctors and patients believed osteoporosis would break women's hip bones.  

A 1985 report in NEJM talked about the positive effect of estrogen on the risk of heart disease. More than 30,000 postmenopausal women participated in the Nurses' Health Study.

It followed the women for more than three years. The study showed that nurses who used estrogen had 70% less risk of developing heart disease.

This news was what Wyeth-Ayerst needed to increase Premarin sales. A pill could beat the odds against osteoporosis and heart disease, the number one killer. There was only a modest increase in breast cancer risk. 

But Premarin would later experience some setbacks.

Further Setbacks Of The Drug Premarin

By 1992, Premarin sales reached their peak in 1975. One out of five postmenopausal women in the United States was taking hormones. The prestigious American College of Physicians recommended preventive hormone therapy to all women. They said ten to 20 years of treatment led to the most benefits.

The American College of Obstetrics and Gynecology recommended HRT for life. Premarin use increased by another 40% over the next three years.

In 1995, Premarin once again became the most prescribed brand-name drug in the US. A 1997 article published in NEJM showed that death went down in women who used hormones. 

In 1998, the results of the first randomized controlled clinical trial of HRT happened. The Heart and Estrogen/Progesterone Replacement Study (HERS), published in JAMA. 

It wanted to determine whether HRT decreased the risk of heart disease in women. Wyeth-Ayerst, the manufacturer of Premarin, agreed to do this study.

They wanted to expand its market for hormones. In 1990, the company told the FDA to approve the drug for heart disease in postmenopausal women. But you can't endorse a drug without clinical trials. 

However, the results didn't go their way. The truth about HRT came out and was difficult for most doctors to accept. 

Premarin Increased Heart Disease In Women

HRT increased women's risk of heart disease by 50% in the first year. Hormone treatments provided no reduction in the risk of developing heart disease. The death rate was not lower in the women who took hormones. It was even higher.

An article in JAMA in 2000 destroyed the reputation of HRT treatments even more. The study showed an 8% per year increase in the risk of breast cancer with combined hormone therapy. 

Despite that, most experts continued to recommend it. Many doctors still prescribe HRT for postmenopausal women.

In 2001, Premarin was the third most prescribed drug in the United States. The Women's Health Initiative(WHI) study was another blow to HRT. 

The Disturbing Truth From The Women's Health Initiative

The WHI study wanted to determine whether routine HRT was beneficial for postmenopausal women. Sixteen thousand women in the study either got combined estrogen and progestin or a placebo. 

The women received letters instructing them to stop taking the study medication. It increased breast cancer, heart attack, stroke, and blood clots. 

The study found a 15% boost in health problems compared with the women who took a placebo. That was about one adverse event for every 100 women who took hormones for five years.

But it didn't stop there. There were two more blows to HRT soon after that. In May 2003, (WHI) showed that combined HRT not only did not prevent Alzheimer's disease. It doubled the risk of developing dementia in women aged 65 and older.

The Women's Health Initiative Study ended earlier than intended in February 2004. After almost seven years, women taking estrogen had more strokes and less broken hips. 

There was no benefit to taking estrogen in postmenopausal women. They also increased their breast cancer risk by 26%.

The final nail in the coffin came with the Million Women Study.

The Final Nail In The Coffin For HRT

One million women in the UK completed questionnaires about their health. They answered if they reached menopause and if they took hormones. 

Women who took hormones had a 66% higher chance of getting breast cancer than the women who didn't take it. The women taking hormones were more likely to die of breast cancer than the other women. 

The study found something disturbing. There had been about 20,000 extra cases of breast cancer caused by HRT in the UK over the previous ten years.

There was another disturbing finding from the Million Women Study(MWS). In the early 1980s, progestins added to estrogen reduced the risk of uterine cancer. Still, nobody evaluated the effect of adding progestin to HRT. 

The MWS confirmed that taking estrogen without progestin caused more uterine cancers. However, adding progestin caused more breast cancers in women over ten years. The problem of uterine cancer was "solved" by adding a drug that increased other cancers.

Luckily, there are natural ways to reduce menopause symptoms without using drugs.

Natural Ways To Reduce Menopause Symptoms

Eating a nutritious plant-based diet may provide relief from menopause symptoms. Hormonal changes during menopause can increase the risk of osteoporosis. Calcium and vitamin D lead to good bone health. It's vital to get enough of these nutrients in your diet.

Adequate vitamin D intake during postmenopause leads to a lower risk of hip fractures. Sunlight is your primary source of vitamin D since your skin produces it when exposed to the sun. 

As you get older, your skin gets less efficient at making it. Supplementing vitamin D may be necessary if you live in a place with less sun.

Leafy greens such as kale, collard, and spinach have lots of calcium. It's also plentiful in tofu and beans.

You need sunshine, calcium, and magnesium to create strong bones. Therefore, make sure that you also get enough magnesium from your diet. Good sources of magnesium include fresh fruit and vegetables, especially leafy greens.

Studies show up to 80% of women are short of essential nutrients, including:

Fruits and vegetables may also help prevent bone loss. One study looked at 3,236 women ages 50 to 59. It found that diets high in fruit and vegetables may lead to fewer broken bones.

Obesity is another reason women may experience menopause symptoms.

Losing Weight Can Reduce Menopause Side Effects

It's common to gain weight during menopause. Obesity can be due to a combination of changing hormones, aging, and lifestyle. Excess body fat increases the risk of heart disease, diabetes, and cancer. Extra body weight may affect menopause symptoms.

One study followed 17,473 postmenopausal women. Over a year, women who lost at least ten pounds or 10% (4.5 kg) of body weight reduced hot flashes and night sweats.

Fruits and vegetables are low in calories and can help you feel full. They're great for weight loss and weight management.

Vegetables may also help prevent some diseases, including heart disease. Heart disease risk tends to increase after menopause. It could be due to age, weight gain, or reduced estrogen levels.

Certain foods may trigger hot flashes, night sweats, and mood changes. Common triggers include caffeine, alcohol, and sugary or spicy foods.

Phytoestrogens are natural plant compounds that mimic estrogen in the body. Therefore, they help balance hormones. Asian countries such as Japan have a high intake of phytoestrogens. 

It may be the reason why menopausal people in these places rarely experience hot flashes. Foods rich in phytoestrogens include soy products, flaxseeds, sesame seeds, and beans.

During menopause, dehydration is often an issue. The decrease in estrogen levels likely causes this. Drinking 8 to 12 glasses of water daily can help with these symptoms.

You can also treat symptoms with herbs.

Herbs That You Can Use To Deal With Menopause

Herbal remedies that are sometimes taken for menopause symptoms include:

Herbal remedies such as red clover contain plant hormones that can act like estrogen. These may help with some menopause symptoms. 

Exercise can release hormones called endorphins. Endorphins help relieve menopause symptoms. They make irritability and mood swings easier to cope with. Even going for short daily walks or doing yoga can help your body.

Reducing stress can help you manage menopause symptoms. Practice relaxation techniques such as deep breathing, meditation, or mindfulness.

Such techniques can help reduce hot flashes and relieve other menopausal symptoms. You can also reduce anxiety, insomnia, and fatigue.