The History of HRT

This week I quietly sat in the sleepy town of Elmore, Ohio, considering the next podcast topic, finally settling on ‘The Truth about HRT’. The podcast episode, which is coming soon, will very much focus on the here and now - the challenges in accessing, the different experiences, the myths, the cost and a whole lot more.

As I have some thought to the topic, I realised how little I actually knew about HRT - I knew it supported menopause and I of course knew that I have a gel to replace the oestrogen I am losing, but beyond that I really had no knowledge about this medicine that has become such an important part of my life. When was it first developed? What exactly is it?

So as I started to prepare the podcast, I also dove into some research to find out more about its history - which was far more interesting than I ever would have thought, including a number of head in hands moments…

Early origins

In discovering where HRT was first developed, we find ourselves travelling back in time to the 1930s and 1940s, with its development well and truly under way. There does appear to be some evidence that even as far back as the 1800s, attempts were being made to treat menopause, with women in Germany being injected with cow ovarian tissue to try to stop the symptoms…

But in terms of HRT, we head first to Canada, where Dr. James Collip (already well established as a pioneer in medicine having been part of the team who discovered Insulin in the early 1920s!) developed the first oral active estrogen, something that he extracted from the placenta of human patients - the name is easy to remember: Emmenin - with some historical sites going so far as confirming that there is no link between this and Eminem!

This was a major milestone in menopause treatment but supply was limited and it was very expensive so it didn’t take long for this to be overtaken by its successors, the most notable of which can be found as we cross the border and arrive into the USA where, in 1942, the FDA ( Food & Drug Administration) approved a new drug Premarin. The approval was not for the treatment of menopause, but for the treatment of ‘Hot Flashes’ - perhaps an early sign that menopause was going to be incorrectly viewed as something that is ‘just a few hot flashes’ for years to come!

How was Premarin developed and is it still in use today? I have to say, I was not expecting what I read about this and I did then check to make sure mine isn’t made this way (it isn’t). So let’s look at the name as therein lies the answer: PREgnant MARe’s urINe! Were you expecting that?

The drug became the most widely prescribed drug by the 1990s and is still well used to this day!

Since the early days of HRT development the ingredients have changed, with focus given to synthetic medication. My own HRT, Oestrogel, is plant-based with the active ingredient estradiol typically sourced from soy or wild yam. Most are produced in the same way now, but there are some common HRT products that are animal-derived so if this would be an issue for you then it is definitely worth making sure you check this.

The Swinging Sixties

When exploring the history of menopause and HRT, the 1960s emerge as an important decade. It was in the 1960s that menopause was reframed by physicians as a natural part of life to being a disease, with them promoting long-term oestrogen replacement - at the time to deal with hot flashes plus osteoporosis.

I’m not sure about using the term disease - we aren’t diseased, and perhaps terming it as a disease has contributed to the silence and stigma that has ensued. Whether we are happy about it or not, it is a natural part of life and framing normalises it. Disease does not.

Now while Premarin was already in use, during the late 1960s its popularity soared. Why? Let me introduce a 1966 bestseller, ‘Feminine Forever’ by Dr. Robert Wilson. Ladies, at this point I’d like to stress that Wilson’s narrative will quite likely lead to the onset of RAGE! Ready?

The name of the book find of gives you a clue, with Wilson claiming that women needed to take oestrogen to retain ‘their femininity’. To be even clearer on the narrative presented by Wilson, his suggestion was that without the oestrogen women would become ‘dull and unattractive’, and if that isn’t bad enough we’d also SHRIVEL up!

How did he get away with this? I started to dig a bit deeper as in my mind the 1960s was all about the explosion of feminism, so why were women - in their droves - buying into this narrative. It probably boils down to a couple of things:

Feminist views on health: at the time it appears likely that feminists were happy to accept the narrative because they saw it as giving back control over their bodies, the ability to take personal control of their health.

Creating fear: the language used in the book was designed to instil fear among women (and apparently their husbands!). I’ve already talked a bit about Wilson’s choice of words, but add to that language suggesting that without hormones, menopause would ‘castrate’ women, make them ‘sexless and unlovable’ and you can see the damage this could cause and explain the rush for the drug that would prevent all of this.

Secret funding: and so it emerged that Wilson had some support in writing Feminine Forever - his work was secretly funded by… wait for it… the Premarin manufacturer! An early example of the monetisation of and manipulation of women during menopause for profit not for support.

Ok, ok before I become too enraged, let’s press fast forward….

The study that changed everything…

HRT continued to enjoy high popularity right through to the 1990s but it was a study launched by the Women’s Health Initiative (WHI) in 1991 that changed all of this - and that caused a lot of damage and suffering for women experiencing menopause. And when I say this, I mean right through to today - it’s something that even Davina commented on in her book ‘Menopausing’ and that fed my own concerns about HRT risks that I raised with my consultant!

So what was the issue? The study involved over 160,000 perimenopausal women and was aimed at determining whether HRT could prevent chronic diseases. And that was all fine until it was halted early, in 2002, with the WHI reporting increased risk of breast cancer, coronary heart disease, stroke and blood clots. They went as far as saying that the risks outweighed the benefits of HRT.

The media had a field day - the UK tabloids started using hugely damaging headlines such as ‘HRT: The Deadly Gamble’, the Daily Mail ‘Hormone pill triple cancer risk ‘, the New York Times going for ‘Study is halted over rise seen in cancer risk’. And when faced with these headlines, it’s hardly surprising that women started throwing their pills away, physicians stopped prescribing - and women returned to unnecessary suffering.

Have you heard about the study? Or heard about these risks ‘on the grapevine’? Keep reading.

In the years proceeding the study being halted and the risk reports being shared, its outcomes have attracted significant criticism from health professionals, who say that while the risks may be relevant to some, the way the data was presented was misleading and distorted to suggest that younger women (under 60) were at risk when in reality this was low to non-existent - and in fact there is data that suggests women who start HRT within 10 years of menopause show a decrease in coronary heart disease! I had definitely heard about the link to breast cancer and interestingly data in the study (which was not a feature of original reports) showed that in women who had a hysterectomy & oestrogen only HRT, cases of breast cancer also decreased.

There are a range of factors that led to criticism of the study, but there was one clear message the study was flawed and women should not be avoiding HRT based on the reported risks. I think, at the very least in America, while there is now a huge amount of information out there that calls this study into question, the impact has remained in tact for far longer than it should. It was only in late 2025 that the FDA started removing ‘black box’ warnings (think cigarette style warnings) from HRT products highlighting risks of dementia, heart disease and breast cancer. Over 20 years after that study came to an end!

A New Era - and we’re living it!

So that brings us to the here and now. It’s been a bit of a rollercoaster ride for HRT, and conversation is still required on ease of access and cost but (hopefully) we are no longer choosing HRT to avoid ‘shrivelling up’ and can feel more confident that in managing our symptoms we are not opening ourselves up to multiple other serious illnesses.

Finding out about the chequered history of HRT has, as I said at the very start of this post, been far more interesting than first anticipated. I for one am grateful that Dr. James Collip, all those years ago, developed that oestrogen pill and equally grateful to know that my HRT is not derived from the urine if a pregnant horse!

And on that note, I sign off! I hope you enjoyed the read…

Rachel x