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history of estrogen therapy

The History of Estrogen Therapy - A Cure for Hot Flashes, Insomnia, Vaginal Discomfort and More?

Hello, menopause! If you’re experiencing any of those symptoms, your doctor may have recommended some form of menopausal hormone therapy.

But is it safe?
When should you start?
And which therapy is right for you?

Researchers have been trying to answer those questions for decades, often with confusing and even conflicting results. Let’s take a look at the history of estrogen therapy, and how past studies are informing the latest recommendations.

A French physician coined the word ‘menopause’ in the 1800s and advanced the revolutionary idea that the health concerns of aging women deserved medical attention. Throughout that century, doctors experimented – sometimes on themselves – with various animal hormones. The science was far from perfected; but by the 1890s, women were being treated successfully for symptoms of menopause with a powder or pill made from cow ovaries.

In the U.S., doctors experimented with bio-identical estrogen replacement and developed a synthetic estrogen replacement in the 1930s. Usage surged over the next several decades, especially after a popular book suggested menopausal hormone replacement could keep women ‘feminine forever’.

The research surged at the same pace; but science couldn’t keep up with seemingly conflicting information, and the market followed its ups and downs. Estrogen was the fifth most prescribed drug in the country by the mid-70s after one study suggested it helped bone growth; but prescriptions plummeted and it earned an FDA warning after it was linked to a rise in endometrial cancer. Conflicting studies on other cancers and cardiovascular health followed, along with FDA investigations. Meanwhile, doctors formed their own opinions and passed them on to women who experienced a wide range of side effects and symptom relief.

Today, hormone therapy remains controversial, leaving many women hesitant to try it, yet suffering in silence from a variety of menopausal symptoms. But as the experts review fifty years of studies, here’s what they know for sure.

Truth takes time.

Many of the earlier studies have been criticized for poor selection of participants and controls; and repeated studies over five decades offer a much better understanding of what hormone therapy can and can’t do. Researchers now say it is still the most effective treatment for hot flashes, genito-urinary discomfort, and preventing bone loss. However, because research still proves inconclusive regarding cardiovascular, stroke, and cancer risks vs. benefits, it’s best used when symptoms impair quality of life, and at the lowest effective dosage.

When (and how long) you take it matters.

Menopausal hormone therapy is safest for women under 60 who begin it less than 10 years from the onset of menopause. The risk of cardiovascular issues, stroke, and dementia rise after that. Timing and duration appear to be related to breast cancer risks as well. For these reasons, estrogen therapy is recommended for short-term use.

Forget one size fits all therapy.

Pills or patches? Estrogen alone or combined with progesterone? How much and how long? Your symptoms and your risks should determine whether hormone therapy is right for you, and what your treatment plan should be. And follow up is critical during this season of change.

When prescribed carefully and used correctly, menopausal hormone therapy can be an effective way to ease symptoms and boost your sex life; but it doesn’t have to be the only way. Pelvic floory physical therapy works on the secondary effects of menopause - the pain you experience due to a drop in hormones. If hormones were the exclusive reason you are having painful intercourse, then adding hormones would be the cure.

But for many women, this is not the case. The musculoskeletal system becomes involved, and a Women's Health pelvic floor physical therapist is not only your advocate - it may just be your solution. Whether or not hormone therapy works for you, a consultation with a women’s health physical therapist to discuss physical therapy for menopause might be just what the doctor ordered!

 

Citation

Kohn G., Rodriguez K., Hotaling J., and Pastuszak A. 2019. The History Of Estrogen Therapy. Sexual Medicine Reviews 7:3 416-29.

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Months after giving birth, it was difficult for me to go from a sitting or lying position up to a full standing position without feeling that I had to remain hunched over until a bit of time had passed to get fully upright. However, after taking Heather’s course, I learned exercises to get my body back to normal. She also showed me correct ways to lift and carry my son as well as put him in/take him out of the carseat and stroller. This class was really beneficial and Heather is a wonderful teacher who made me feel very comfortable.

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Testimonial by Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

Testimonial by M.N., age 28

A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

Read more: Testimonial by M.N., age 28

Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

Read more: Testimonial by T.H.

Testimonial by J.H.

My last appointment with Heather was over 6 years ago but I still think of her every day. I don’t take for granted that I can easily get out of bed, care for my two active and busy young boys, run, play tennis, clean my house, or sit at a desk for several hours at a time. None of these tasks were easy for me before meeting Heather. Eight years ago my car was struck from behind by a tractor trailer that was estimated to have been speeding. I spent 3 years working with different PTs and Drs trying to heal and move on with my life. When I became pregnant and the hormone relaxin that “relaxes” all the joints of the body and the additional weight gain erased all my progress and I was suddenly in a lot of pain again. My OB sent me to Heather for one last try.

Read more: Testimonial by J.H.

Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

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