The Graceful Change

Menopause can be a trying time for women, but with a healthy yoga practice, stress about hormone replacement therapy doesn't have to be part of the picture.

By Trisha Gura

Hormone replacement therapy was first popularized in 1966 by physician Robert Wilson. His best-selling book, Feminine Forever, suggested that estrogen supplements could help control the hot flashes, fatigue, irritability, and other symptoms related to declining estrogen levels during perimenopause. Many women and their physicians eagerly sought the new drug treatment.

In the 1970s, though, the first black cloud appeared. Two major studies published in the New England Journal of Medicine showed that estrogen supplements could increase the risk of cancer in the lining of the uterus. Pharmaceutical companies responded by offering new formulas that combined estrogen with another hormone, progesterone, which had been shown in numerous studies to counter the increased risk of uterine cancer from taking estrogen alone.

By the 1980s, research had suggested that the estrogen-progesterone combination could also lower the risk of heart disease, osteoporosis, and perhaps even Alzheimer's disease. The studies showing these benefits, however, also showed that estrogen-related drugs could increase the risk of breast cancer. Perhaps more important, the trials were not definitive. Some were quite small; others used an observational approach--that is, researchers interviewed women who had chosen to take hormones (or not) and followed up with them for a number of years to record any health troubles. This approach is far from the gold standard for medical research, as the results can easily be misleading. For example, women who chose to take HRT tended to have a healthier lifestyle than those who didn't. So while those taking hormones fared better at the end of the study, it wasn’t clear if this was a result of the drugs or their better overall health.

For researchers to be certain that HRT could help prevent disease, they needed to perform a double-blind study with a control group. In 1993, scientists recruited more than 16,000 postmenopausal women and randomly assigned them to take either the most widely prescribed hormone combination (Prempro) or sugar pills. The eight-and-a-half-year trial was dubbed the Women's Health Initiative (WHI).

In the middle of the trial, though, a hurricane hit. Researchers discovered that Prempro was actually increasing--not decreasing--the risk of heart disease, blood clots, and stroke. Add to this the previous data on increased breast-cancer risk and researchers arrived at a difficult verdict: HRT poses significant health risks for postmenopausal women that generally outweigh the drugs' benefits. In July 2002, WHI officials halted the trial three years early and advised the postmenopausal study participants to quit taking HRT.

Where does that leave HRT? Researchers are now focusing on whether different kinds of hormones, especially plant-based estrogen, might offer relief from symptoms without increasing the risk of disease. And they're interested in learning how HRT affects younger women. The WHI study participants were between the ages of 50 and 79. Might younger, perimenopausal women safely take hormones for shorter periods of time (less than four or five years) to combat severe hot flashes and insomnia? We won't know for certain until additional studies are completed.

—T.G.

Trisha Gura is a freelance science writer and yoga student in Boston. Linda Sparrowe, a Yoga Journal contributing editor, is the author of YJ's coffee table book, Yoga, and coauthor (with Patricia Walden) of the forthcoming book Yoga for Healthy Menstruation.

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