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What is Hormone Replacement Therapy?

As a woman's body ages, the cyclical supply of her body's primary sex hormones begins to wain, 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.

Increases in medical knowledge during the latter part of the twentieth century, showed that supplemental estrogen given to women as they entered this menopause phase of life, seemed to prolong quality of life, and even life itself. The most common form of supplemental estrogen prescribed over the past several decades has been a conjugated estrogen product called Premarin¨.

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

But soon another problem became evident -- the supplemental estrogen HRT program would cause a woman's body to prepare for holding an embryo and fetus, which never came. The swollen uterus would, in some women, finally develop uterine cancer in response to this constant stimulation by estrogen.

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

However, there is no form of supplemental progesterone hormone which could survive the digestive system, or which could be given transdermally (via a patch) or via an injection. So 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.

And although many women have found an inability to use progestins -- usually medroxy-progesterone -- without substantial additional medical and psychological problems, this drug continues to be highly prescribed.

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

Some women find that with the significant decline in their body's estrogen or progesterone or both, there are significant emotional problems. For some women, this is manifested as a depression, for other women, this manifested 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 during the past 2-3 decades, 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. This combination of estrogen plus progestin was in the news in July 2002, as having caused increased health risks during a major study.

Unfortunately, most of those news reports seemed to implicate all HRT regimens as bad, 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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