Prescribing estrogen therapy for women has been a controversial subject for decades. And if you are one of the many women making a decision about hormone therapy today, it will help if you understand some of the history behind this practice. Ultimately the decision to use hormone replacement therapy (HRT) is an individual one made between a woman and her doctor. But it can be eye-opening to get some perspective on how estrogen therapy came about, why it fell out of favor and how it came back on the radar to again become the subject of intense debate.

The rise and fall of estrogen

In 1941, the Food and Drug Administration approved estrogen replacement for treating symptoms of menopause. In the years following the first estrogen replacement prescriptions, observational studies confirmed its benefits. By 1960, Dr. Robert A. Wilson’s bestselling book, Feminine Forever, convinced women that menopause was caused by an estrogen deficiency which could be completely avoided by estrogen supplementation. This book promised that women would feel younger and happier and gave everyone hope that estrogen replacement would prevent many of the diseases that become more common as we age.

But in 1975, two studies reported that estrogen treatment increased the risk of endometrial cancer, bringing estrogen therapy prescriptions to a halt. Yet within the decade, new studies showed that adding progesterone to estrogen treatment eliminated the cancer risks. By 1992, Premarin (estrogen made from the urine of pregnant horses) was the most frequently prescribed drug in the US.

The Women’s Health Initiative

Estrogen (and progesterone) replacement prescriptions plummeted again in 2002 after the Women’s Health Initiative (WHI) results showed that use of Prempro (the combination of estrogen and synthetic progesterone) increased the risk of breast cancer, heart disease, stroke, and blood clots. Women were abruptly taken off prescriptions without being provided any other options for controlling their symptoms. Many women turned to doctor-prescribed antidepressants or ended up suffering hot flashes, insomnia, weight gain, and mood changes because they had nothing else to turn to.

More recently, scientists have re-analyzed the WHI data and determined that there were major flaws in the study. For example, many women in the study were 10 and 15 years away from menopause. Others had hypertension and/or diabetes, already increasing their risks for the other conditions.

Hormones as a form of false hope

What’s interesting is that so much of the positive hype around estrogen was based on very little research. It shows us that hope is a powerful thing — especially when it comes to promises of youth. Dr. Elizabeth Barrett-Connor writes in her review of the book The Estrogen Elixir: A History of Hormone Replacement Therapy in America, “Estrogen is about hope. Industry hype associating hormone-replacement therapy with youth and beauty began early and continues today. In this regard, an unretouched photograph of a stooped, wrinkled, old woman side by side with a ‘Botoxed’ celebrity is worth a thousand words.”

At Women’s Health Network, we focus on health, rather than on the fantasy of finding a fountain of youth. This is why we always promote a holistic view of the body, taking into account how it works, and highlighting hormone-balancing foods and nutrition, good sleeping habits, stress-reduction, regular exercise routines, and prioritizing fun in your life. We also advocate for the safe use of herbs to resolve menopause symptoms, if the prior steps aren’t making a big enough impact. And in the end — for some women — hormones are truly the best answer.

What to do about HRT

As mentioned above, the decision to use hormones is entirely individual. The practice remains controversial and is subject to a woman’s family and personal health history, as well as her age and the type and severity of her symptoms. The jury is still out on estrogen, and only time will tell if our current thinking is correct. Director of the Yale Prevention Research Center, Dr. David Katz, writes in a Huffington Post blog on estrogen therapy, “Evidence accumulates over time, and the weight of evidence tips toward the truth. When science becomes a teeter-totter of sequentially opposed truths, we have lost our way.”

Estrogen, and HRT in general, has come in and out of popularity and it seems as if we, as a culture, have lost our way on finding what’s best for women. While scientists hammer out the details of hormone replacement therapy, we advise starting with the least invasive approach to relieving menopause symptoms. That means making a few hormone-healthy food and lifestyle changes and supplementing with hormone-balancing herbs. We’ve made it easy with our Hormonal Health Program because we know that with a little support, your body knows exactly how to achieve balance naturally.

For more information on HRT and lowering your risks, read our article The real risks of HRT.