There is More to HRT Than Replacing Estrogen

This week, Brett Newcomb and I will be discussing the terms Hormone Replacement Therapy (HRT) and Estrogen Replacement Therapy (ERT), and what is meant by the term “hormones”. We are concerned because so many women are still confused about how the term “hormone” is generalized to mean estrogen when, in reality, “hormone” can be any one of a hundred substances made by the body. Because of this generalization and conflicting research, women have been scared into a state of immobilization. When we can’t trust what we read or hear, we are led into making poor decisions which results in most women not receiving anything to replace their estrogen, testosterone, and progesterone when they enter their 40s. First, ERT means that the patient is only getting estrogen of some kind (estradiol, synthetic estradiol, estrone, estriolm, or Premarin—estrogen from horses,) but is not receiving progestins, usually because they have had a hysterectomy. HRT means that the patient is receiving estrogen of some kind and progestin, usually Provera. This is added to estrogen to protect the uterus from bleeding and to prevent uterine cancer. Now for the falsehoods and generalizations: Many women, and even their doctors, still believe that replacing estrogen after menopause will increase their chance of developing breast cancer. This was the report from one study in 2002 by WHI, which has been re-visited and found to be a poor study, misrepresenting the risks of estrogen. The real findings were that estrogen-alone ERT, did not increase the risk of getting breast cancer and, in fact, the study group on ERT had fewer cases of breast cancer than the group who took nothing. This initiative was cancelled before it was finished and its conclusions were widely broadcast because the researchers felt that they had uncovered a major risk for women who were receiving HRT. The increase in breast cancer was among the HRT group who were taking progestins with their estrogen. So, it was really progestin that was the problem. I discuss this in detail in our book The Secret Female Hormone, if you want the whole story.