Published February 21, 2018
Why are we dealing with this controversy almost seven decades since Estrogen is being used by women? The first Estrogen to be approved by FDA in 1941 was Premarin, synthesized from pregnant mare’s urine. It was not until 1963, however, when Robert Wilson, MD, a Gynecologist and his wife Thelma, a nurse, wrote an article in the Journal of the American Geriatrics Society that Premarin gained popularity. Later in 1966, his book “Feminine Forever” was published and received rave reviews in the press and further boosted the sale of Estrogen as a panacea against aging. In the 1970’s, a connection between Estrogen and Uterine cancer surfaced, instilling fear and dropping the sale of Premarin. It became apparent, after further research, that adding Progesterone would prevent uterine cancer. This lead to the making of PremPro; a drug which contained a synthetic progestin in addition to Premarin.
Although growing concern of the drug causing cancer was being echoed in Cancer research journals, Premarin became the #1 prescribed drug in the US in 1990. This was possibly due to aggressive marketing by the Pharmaceutical company, Wyeth, which touted the properties of the drug not only for menopause, but also for prevention of heart disease, a major cause of death among women. In addition, the Nurse’s Health Study(http://www.nurseshealthstudy.org/) and Framingham study (https://www.framinghamheartstudy.org)
suggested that women who took hormone therapy had lower rates of heart disease and lived longer. In order to confirm these observations and to answer other questions regarding cancer risk a largescale study, the Women’s Health Initiative (WHI) was launched in 1993.
The study enrolled 161,808 postmenopausal women between 50 and 79 years age who received either Premarin, PremPro or a placebo. The study was discontinued after 5½ years when they identified increased risk of Coronary Artery Disease (CAD), stroke, breast cancer and ovarian cancer in women taking PremPro. They did not find these risks in women that took Premarin alone. Both groups had decrease in colon cancer and osteoporosis. The study result was released in all major newspapers and a fear of taking Estrogen arose and has persisted.
That was 2002, but today, more than 15 years later, misconceptions remain. However, new data has emerged from not only new research, but reanalysis of WHI data for different age and ethnic groups that throws some light on this controversy.
Here is a summary:
1. Hormones in WHI consisted of synthetic estrogen and progestin. It is now evident that it is the synthetic progestin which is responsible for the increased risks of cancer and CAD, since Estrogen alone did not increase these risks in the study group. Additional research has corroborated these findings. Women with an intact uterus need to take Progesterone in order to protect their uterus from cancer, but not those who have had hysterectomy. Other Progesterone preparations are available with possibly lower risk of breast cancer.
2. The timing hypothesis: When you start taking hormone therapy, in relation to onset of menopause, this makes a difference in your risks. Women who start hormones within 10 years of menopause have significantly lower risk and may have protective benefits against CAD compared to those who initiate hormone therapy at an older age of 60 or over.
3. Vaginal Estrogens are safe alternatives to treat Genitourinary Syndrome of Menopause (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561742, which consists of postmenopausal vaginal dryness, pain and urinary symptoms.
4. Estrogen is effective in preventing Osteoporosis and fractures. Long term Estrogen usage is protective against colon cancer, vaginal atrophy and diabetes.
5. Are some Estrogen and progesterone safer? There are many preparations, different doses and routes of delivery which could better serve some women. One size does not fit all and therapy must be individualized to address each and every woman’s needs, her symptoms, medical history, risk factors personal preference and quality of life concerns.
North American Menopause Society (NAMS: www.menopause.org) published a position statement in 2017 which clearly defines this individualized approach.
To learn more about menopause and related concerns please call 6145835552 or visit www.cwc4women.com to consult Uma Ananth, MD, who specializes in Menopause. Get all your questions answered.
Disclaimer: The information included on this site is for general educational purposes only. It is not intended nor implied to be a substitute for or form of patient specific medical advice and cannot be used for clinical management of specific patients.