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Stephen B. Hulley, MD, MPH; Deborah Grady, MD, MPH

JAMA. 2004;291:1769-1771.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Over the past half-century, a growing belief among women and their physicians held that "replacing" the estrogen lost at menopause would prevent many of the manifestations of aging, including coronary heart disease (CHD), osteoporotic fractures, and a decline in cognitive and sexual function. This attractive and plausible view led to widespread use of hormone therapy after menopause in the era before randomized trials with disease end points were required for proving the effects of new drugs. Clinicians were drawn in by other accumulating lines of evidence for CHD benefit that were consistently favorable: observational studies showed less heart disease among women taking estrogen,¹ pathophysiologic mechanisms provided biological plausibility,² and clinical trials revealed improvements in blood lipid levels and other surrogate measures.³

A fateful bump in the road in the 1980s was the recognition that postmenopausal estrogen treatment was causing endometrial cancer.⁴ . . . [Full Text of this Article]

Author Affiliations: Department of Epidemiology and Biostatistics, University of California, San Francisco.

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