The Hormone Replacement Therapy Controversy
By Elizabeth Lee Vliet, MD
Excerpted and condensed from
It’s My Ovaries, Stupid,
Hormones—and their connections in how we think and
function—have been my life’s work. The summer of 2002
brought a maelstrom of negative, frightening headlines
abput “hormones” and hormone replacement therapy. The
headlines screamed that estrogen increase the risk of
breast cancer. The newsmakers said hormone replacement
therapy causes heart attacks and strokes, not prevents
Women are now afraid to consider birth control pills or
menopause hormone therapy. We are made to feel terrified
about hormones our bodies make naturally our entire
Why suddenly such intense negative focus on estrogen?
What is really going on here?
Negative reports from the Women’s Health initiative (WHI)
and Heart and Estrogen/progestin Replacement Study (HERS)
hit the media like a nuclear explosion in the summer of
2002. Each of these clinical trials used only one form of
estrogen—Premarin—derived from the urine of horses, and a
synthetic progestin—Provera—both hormones not at all
identical to anything our bodies ever made naturally, a
point rarely mentioned in the coverage. There are many
well-studied, alternative, bioidentical (or “natural”
forms of hormones available, with fewer negative side
Why don’t we get a full picture of the studies? Why are
the negative results trumpeted and crucial positive
findings downplayed or ignored? The press shouted that
there was a 26% increase in risk of breast cancer. What
they didn’t say was that statistical increase was minute.
The alarmist headlines made it appear that more women died
taking hormones. This was not so.
The focus on fear of breast cancer appears to sell
newspapers and magazines. That same fear is used to sell
everything from herbs and soy supplements to new and
expensive “designer estrogen” prescription products.
Instead of educating women with balanced information, we
are bombarded with poorly researched and hastily presented
stories with a biased focus on breast cancer to the
exclusion of other disorders that kill many times more
women every year.
We must strip away the myths surrounding hormones and
hormone therapy, including such misconceptions as
“Hormones cause cancer,” “All estrogens are the same,”
“All progestins are the same,” and “How you take hormones
- Women need straight talk, sound information, and
more of the complete story behind the headlines.
- Environmental endocrine disruptors interfere with
the function and production of human hormones and
increase cancer risk. We need to recognize and research,
expose and identify these hormone saboteurs and toxins
that are often ignored.
- The cookie-cutter approach cannot continue. One form
of estrogen derived from pregnant horse’s urine has been
used for about 85% of all hormone replacement therapy
prescriptions—despite the fact that bioidentical
hormones have been available since 1976.
- Bioidentical human forms of hormone products need to
be used instead of horse-derived or synthetic progestins
that have very different and often negative effects on
the human body.
- “One size fits all” is no longer acceptable. Women
are individuals, with individual body chemistries. Women
vary in response to hormones just as they do to other
classes of medicines (and herbs). Women must have
hormone options individually tailored to their needs.
- We must measure hormones with objective tests.
“gold standard” serum (blood) tests for hormone levels
are reliable for management of infertility in younger
women. We must apply these same tests for management of
midlife and menopausal hormone issues. Saliva tests and
hair analysis simply are not adequate for the complexity
of women’s issues.