What is Hormone Replacement Therapy?

As a woman’s body ages, the cyclical supply of her body’s primary sex hormones begins to decline, ultimately diminishing to the point that even life itself can be jeopardized. Until the late 1940s, many women who went through menopause, died shortly thereafter.

Advances in medical knowledge beginning the 1960′s, showed supplemental estrogen given to women as they entered the menopause phase of life seemed to prolong quality and length of life. The most common form of supplemental estrogen prescribed over the past several decades has been an estrogen product called Premarin; manufactured from PREgnant MARe uRINe.

The whole regimen of supplemental, drug-based hormones is called Hormone Replacement Therapy (HRT).

Supplemental estrogen HRT programs cause a woman’s body to react as if it is preparing to carry a fetus, which never happens. In some women after prolonged use of supplemental estrogen HRT, the swollen uterus would finally develop uterine cancer in response to this constant stimulation by estrogen.

Doctors found that if a woman’s body also received supplemental progesterone for a short period of time each month, the combination of the two supplemental hormones given on a cyclical regimen would mimic the naturally cyclical hormones of the pre-menopausal woman. The combination HRT create a menses to cleanse the uterus, virtually eliminating the potential for uterine cancer caused by HRT.

Research has not identified any form of supplemental progesterone hormone which can survive the digestive system, or which could be given transdermally (via a patch) or by injection. A synthetic version of progesterone was developed which could survive the digestive system, called medroxy-progesterone (brand name “Provera”).

These synthetic forms of progesterone are in a class of hormone-like drugs called Progestins. Progestins are preparations — drugs — that have effects allegedly similar to those of the natural hormone progesterone.

Many women have found that using Progestins — usually the prescription drug Provera a.k.a. medroxy-progesterone — causes substantial additional medical and psychological problems. However this drug continues to be highly prescribed.

There are additional problems which may occur during menopause, as well.

Some women find with the significant decline in their body’s estrogen or progesterone or both, there are significant emotional problems. For some women this manifests as depression, in other women this manifests as aggression and anger. For a few unlucky women, there are mood swings between depression and anger…

So the generally accepted Hormone Replacement Therapy (HRT) for menopausal women until the late 1990′s, has been a constant supply of supplemental estrogen (most often Premarin), with a 10-14 day cycle of progestin (most usually Provera) added during the month to force menstruation, in order to reduce the potential for uterine cancer.

The maker of Premarin then brought to market a combination drug consisting of Premarin combined with Provera, called “PremPro”, which has become THE dominant  prescription drug for PMS and/or menopause over the past decade. This combination of estrogen plus progestins has been heavily in the news since July 2002, as having caused increased health risks during a major study conducted by the Women’s Health Initiative.

Unfortunately, most of those news reports seemed to implicate all HRT regimens as bad, and as problematic for women.

So is Hormone Replacement Therapy a good thing or a bad thing for women?

Overall results over the past four to five decades seem to strongly indicate that HRT — properly administered and managed — is a very good thing for women; with the caveat that some women will have problems, anyway, during menopause, and that a very few women will fair less well on HRT, than without any supplementation at all.

The quest then is to find the safest form of HRT for those women who need to supplement their body’s declining hormone production as these women age.

Your PMS history is generally a good predictor of how much of a problem your menopause can become.

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