Failure of Estrogen Plus Progestin Therapy for Prevention

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Abstract
Approximately 38% of postmenopausal women in the United States use hormone replacement therapy.1 In 2000, 46 million prescriptions were written for Premarin (conjugated estrogens), making it the second most frequently prescribed medication in the United States and accounting for more than $1 billion in sales, and 22.3 million prescriptions were written for Prempro (conjugated estrogens plus medroxyprogesterone acetate).2 While US Food and Drug Administration–approved indications for hormone therapy include relief of menopausal symptoms and prevention of osteoporosis, long-term use has been in vogue to prevent a range of chronic conditions, especially heart disease. Estrogen alone was the dominant hormone until the increased risk of endometrial cancer led to the addition of progestins for women with an intact uterus. Since the mid-1980s, combined estrogen/progestin use has steadily increased.3