Feminine Forever Revisited: Menopausal Hormone Therapy in the 1990s

Abstract

In the mid-1960s, postmenopausal women were encouraged to take estrogen therapy for the rest of their lives (feminine forever), and millions of American women did exactly that. However, subsequent reports of an increase in stroke and heart attack among men given high doses of estrogen and in women using estrogen-containing oral contraceptives frightened many women as well as their physicians. Further, reports in the mid-1970s that estrogen use caused endometrial (uterine) cancer resulted in millions of women ceasing therapy and in the adoption of conservative prescribing and use patterns. However, the decade of the 1980s brought renewed interest in the benefits of estrogen use, as a growing and coherent body of literature identified exogenous estrogen as protective against osteoporosis, osteoporotic fracture, and cardiovascular disease. The practice of adding a progestin to an estrogen regimen was introduced to prevent the (estrogen-induced) increase in uterine cancer. As the 1990s unfold, additional benefits of estrogen therapy are being illuminated, and additional potential risks are being evaluated. In the absence of evidence from randomized clinical trials there remain, for some, questions about the validity of the current scientific data. However, for many, the abundance and coherence of the data documenting the benefits of estrogen are leading to an affirmation of the old concept of feminine forever, or universal, long-term hormone therapy for postmenopausal women.