Observations and advertising: controversies in the prescribing of hormone replacement therapy

Since scientists in the 1930s discovered sex hormones, hormone replacement therapy (HRT) has been a source of considerable controversy and debate. This debate continues with the publication of the results of the Women's Health Initiative, a large randomized controlled trial that has once again altered the way women and their care providers view this therapy. Over the years the evidence increasingly has suggested that HRT is not effective for the prevention of cardiovascular disease in women. However, the prevailing opinion denied this, and millions of women were prescribed estrogen with or without progestin under the assumption that cardioprotection was possible. Why did this practice continue in the face of mounting evidence of harm? In this article we will explore the role that the media and pharmaceutical companies have played in the widespread use of these hormones despite evidence of significant side effects and lack of prevention efficacy.