The Truth About Hormones 03 ( By TIME - Jul. 22. 2002 )

Those were different times, of course. But the idea that a single pill might turn back the clock quickly caught the popular imagination. It didn't hurt that the hormone's No. 1 manufacturer, Wyeth Pharmaceuticals, launched an aggressive marketing campaign. Thank goodness today's spots have been updated to feature the dulcet tones of singer Patti LaBelle and have abandoned patronizing messages like the one in a 1975 ad--"Almost any tranquilizer might calm her down...but at her age, estrogen may be what she really needs."

Over the years the medical arguments for prescribing estrogen were also updated. "The vapid cowlike state was gone, and there was very scientific language about bone density and heart disease," explains Cynthia Pearson, executive director of the National Women's Health Network, a longtime skeptic of HRT.

It all seemed so logical and convincing. Women are much less likely than men to suffer heart attacks and strokes in their 30s and 40s. But when natural estrogens stop flowing after menopause, women's risk quickly catches up to men's. Clearly estrogen has some kind of positive influence. And sure enough, a number of studies in the 1980s showed that women who took the hormone at menopause had lower levels of LDL cholesterol, the so-called bad cholesterol, and higher levels of HDL, the so-called good cholesterol, than those who didn't. The benefits of supplemental estrogen couldn't be more obvious.

Biology, alas, is rarely so straightforward. Researchers came to realize that it wasn't safe to give estrogen alone to a woman with an intact uterus. Unopposed estrogen, as it is called, dramatically increases the chances that a woman will develop uterine cancer. (Obviously, this isn't a problem for women who have undergone hysterectomies.) The addition of progestin, another female hormone, seemed to take care of that problem.

The conviction that long-term HRT was beneficial became so entrenched that doctors who delved into the issue more closely were surprised to discover how thin the evidence was. In the early 1990s, Dr. Deborah Grady of the University of California at San Diego was asked to help write guidelines on HRT use for the American College of Physicians. She remembers growing increasingly uncomfortable as she sifted through the scientific literature. None of the studies were definitive. Most were observational studies that showed that women who took HRT lived longer and with fewer health problems than those who didn't. Perhaps HRT was the real reason, or perhaps women on HRT were simply more health conscious than their counterparts. No one could say for sure.

Even the studies that showed that estrogen improved a woman's cholesterol profile weren't ultimately all that satisfying. After all, plenty of women with normal cholesterol levels still have heart attacks. What was needed was a hard-core clinical trial so rigorously designed that no one could contest the results.

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