In the years since America first came to know and love her as Crissy Snow on “Three’s Company,” Suzanne Somers has made millions of dollars selling clothes, exercise equipment, and books, seven of which have become bestsellers. Her latest book, “Ageless,” has drawn the ire of some doctors for touting the benefits of something called “custom-compounded bioidenticals,” an alternative form of hormone replacement therapy (HRT) for menopausal women that requires a doctor’s prescription but is not FDA approved. Dr. JoAnn Manson, author of “Hot Flashes, Hormones, and Your Health” and a leading expert on HRT, was invited on TODAY to discuss menopause treatments. Read an excerpt of her new book:

Chapter 3
The Rise and Fall and (Cautious) Return of Hormone Therapy
Once prescribed primarily to cool the hot flashes and dry the night sweats of menopause — two things that it is very effective at doing — hormone therapy (formerly called hormone replacement therapy, or HRT) has for several decades also been promoted as a strategy to forestall many diseases that we associate with aging and that tend to accelerate after menopause, including heart disease, memory disorders, and osteoporosis. Indeed, more than two of five menopausal women in the United States were taking hormone therapy in 2001.1 In addition, it was becoming increasingly common for doctors to begin prescribing hormone therapy for women in their 60s and 70s and even for women with a diagnosis of angina (chest pain) or previous heart attack. So strong was the belief that estrogen protected the heart and that women of all ages could benefit, many women were being started on hormone therapy 20 to 30 years after the onset of menopause. This widespread use was unwarranted, especially among older women, given the lack of conclusive data on the long-term health consequences of such therapy.

Recent results from the Women’s Health Initiative (WHI), a major national clinical trial of hormone therapy in healthy women who were on average more than a decade past menopause, not only appear to refute the idea that supplemental estrogen keeps the heart healthy in older women but also suggest that, when taken in combination with a progestogen (as it normally is to protect against endometrial cancer), it may actually increase the risk of heart disease. Moreover, the WHI findings indicate that supplemental estrogen offers no protection against chronic disease overall, and that the health risks associated with estrogen-plus-progestin therapy may outweigh the benefits. However, very few women in the WHI were newly menopausal (within five years of menopause), so the study could not conclusively address the benefits and risks of hormone therapy in that group.

When the first of these unexpected results was announced in July 2002, physicians and other healthcare providers across the country were deluged with calls from frantic patients asking, “What went wrong? I thought hormones were supposed to be good for me — not just relieve my symptoms but keep me healthy!” and, even more urgently, “What do I do about hormone therapy now?” And many doctors found themselves unprepared to provide satisfactory answers to these questions.

It’s important not to judge these physicians too harshly. Yes, some were unprepared simply because they had not critically examined the earlier scientific data underlying the belief that hormones were “healthy” for women of all ages and risk factor status. But others were unprepared because balancing the benefits and risks of hormone therapy for any particular patient can challenge even the most knowledgeable of healthcare providers, including those with a nuanced understanding of the strengths and weaknesses of the existing research.

In this chapter, I’ll review how medical research works and how medical thinking regarding menopause hormones has evolved over time — or, as billed in the title, the rise and fall and (cautious) return of hormone therapy. The material covered here is a useful prelude to the detailed look at what we know today about the health benefits and risks of supplemental estrogen that is presented in the next chapter.

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