Hormone Therapy

Hormone therapy or hormone replacement therapy (HRT) is the use of the hormones estrogen and progesterone by women to alleviate various “natural” mental and physical discomforts associated with menopause. The wide use of HRT has helped medical-ize menopause, thus turning a nonmedical problem into a deficiency disorder. In addition, hormone therapy may be viewed as a form of socially enacted control over the so-called deviant behaviors women exhibit as they go through menopause.

Hormone replacement therapy is used to treat the symptoms experienced during menopause and postmenopause. Menopause is the transition period women experience as they cease regular menstruation, thus marking an end to their reproductive period. It is a naturally occurring or natural life process. According to the Centers for Disease Control and Prevention, women typically make this transition between the ages of 45 and 55, noted by the absence of menstruation for a continuous 12-month period. It may also occur earlier (i.e., induced menopause) because of medical procedures such as hysterectomies or cancer treatments including chemotherapy or radiation to the pelvis. Menopause is technically not a medical diagnosis, but a label used to identify the closure of a woman's reproductive ability. As women transition through menopause, there is a decrease in the production of two hormones—estrogen and progesterone—which can lead to various mental and physical discomforts. These include (but are not limited to) feelings of warmth in the face/neck or upper torso (i.e., hot flashes); sleep disorders (e.g., night sweats, fatigue); tension and stress; vaginal issues such as wall thinness, dryness, vaginal itching, painful sex, and irregular vaginal bleeding; osteoporosis; for-getfulness; and dizziness.

Although hormone replacement therapy had its start more than 100 years ago, until the 1960s, the use of extracted and synthetic estrogen on women was limited. In 1966, based on select medical research, hyperbole, and a financial stake in the use of HRT, Robert A. Wilson published the popular book Feminine Forever, which advocated HRT use in treating menopause, and to retain and even bolster women's experience of femininity and beauty. In addition, claims were made that HRT also prevented some forms of cancer. The popularity of the book, in conjunction with exposure in the popular media and the accessibility of estrogen (e.g., its availability, low cost, and ease of delivery), led to a drastic increase in prescriptions of HRT through the late 1960s into the 1970s.

However, estrogen HRT was beginning to yield health risks that outweighed the benefits. Some of these risks (e.g., endometrial cancer) were becoming pronounced in the late 1970s, leading to a decline in HRT prescriptions from 30 million in 1975 to about 15 million at the beginning of the 1980s. Yet, prescriptions climbed again through the 1980s as progestins were used in combination with estrogen, and as oral combinations of these hormones became available, prescriptions climbed to 91 million in 2001 (representing 15 million postmenopausal women). In 2002, two landmark studies published questioned the benefits of HRT. The Heart and Estrogen/Progestin Replacement Study (HERS II) showed that the one of the perceived benefits of HRT—reduction in coronary heart disease—could not be substantiated. The Women's Health Initiative (WHI) trial provided evidence that HRT was harmful, with increased risk of [Page 441]some coronary heart events, strokes, and breast cancer. A host of additional studies since 2002 have continued to show severe negative health consequences of HRT.

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