During menopause, natural estrogen levels in a woman's body decline causing symptoms like hot flashes and mood swings. For many years, estrogen replacement therapy was recommended to relieve menopausal symptoms. As the egg supply in the ovaries is depleted, they begin to produce less estrogen and finally shut down completely. Other organs produce estrogen as well, so even after menopause it is still present in the blood stream, just at much lower levels than when a woman was young.
In the 1930's, scientists found that they could isolate the natural estrogen from the urine of pregnant women, but continued to search for other sources, in order to make mass production possible. During that decade, researchers learned to create estrogen in the laboratory and isolate it from the urine of pregnant mares.
In 1941, estrogen replacement therapy was approved by the FDA for the treatment of menopausal symptoms.
Estrogen replacement therapy was very popular until around 1975 when researchers learned that it could cause endometrial cancer. The endometrium is the lining of the uterus. Natural estrogen produced by the ovaries causes the lining to thicken, preparing for a fertilized egg. During a woman's reproductive years, if no egg is fertilized, the ovaries produce progesterone, which causes the endometrium to be shed during menstruation. Estrogen replacement therapy caused the lining to thicken, but since progesterone was not present, the lining was not shed, resulting in cancer of the endometrium in many women.
To reduce the risk of endometrial cancer, doctors began to prescribe a combination of progesterone and estrogen replacement for women during menopause. This "combination therapy" was very popular until 2001, when the Women's Health Initiative found that the health risks associated with this therapy outweighs the benefits. Hormone replacement therapy had been commonly recommended, not only to reduce the symptoms of menopause, but also to reduce a woman's risk of colorectal cancer and osteoporosis.
During the five year study, researchers followed groups of women who were using either estrogen replacement only, combined hormone replacement therapy or a placebo (no HRT at all). Researchers had originally intended to follow the women for several more years, but research was halted because of the number of reported adverse events among women using HRT. The adverse events reported were breast cancer, heart disease, blood clots, stroke and pulmonary embolism.
The information collected by the research group indicates that while combination HRT decreases a woman's risk of endometrial cancer, it increases a woman's risk of breast cancer. One group of women in the study was able to use estrogen replacement only, because they had previously had a hysterectomy, thus estrogen posed no threat of endometrial cancer. After comparing the incidence of breast cancer in this estrogen only group to the group using combination HRT, researchers concluded that the combination therapy increased a woman's risk of breast cancer. Topically applied hormones, such as natural estrogen creams, are not believed to carry the risks of orally administered hormones.
Some brands of HRT are advertised as "natural estrogen" because the source of the estrogen is natural; mare urine. Some people refer to bio-identical hormones as "natural", because they are designed to be molecularly identical to the natural estrogen and other hormones created by a woman's body.
Bio-identical hormone replacement therapy is somewhat popular, due in part to a book written by a female TV star, who upon entering menopause was unhappy with everything that went along with it and found a clinic that offers this form of treatment. It is more expensive and not available from all doctors. Basically, bio-identical HRT involves creating hormones in the laboratory that are structurally identical to a woman's own hormones. Compounding pharmacists use plant estrogens from yams and soy, as well as animal estrogens from horses and pigs and "adjust" them, so that they are so similar to the ones produced by the human body, that, theoretically, the body can not tell the difference. To date, no studies have been conducted concerning the health risks associated with the long term use of bio-identical HRT.
Rather than offering the quick fix of estrogen replacement or other types of HRT, some of the best women's clinics begin treatment by counseling women about diet, nutrition, lifestyle and dietary supplements. In many cases, making healthy changes in lifestyle and diet and adding nutritional supplements helps to increase a woman's natural estrogen levels, relieves menopausal symptoms and makes HRT unnecessary. To learn more, please visit the Menopause and PMS Guide.
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