Hormone therapy (HT) has been called life-changing, dangerous, misunderstood, miraculous—and let’s be honest, it’s been a whole mess for decades. So how did we get here?
Dr. R.D. Langer’s deep-dive article, “The Evidence Base for HRT: What Can We Believe?” pulls back the curtain on one of the biggest controversies in women’s health: how the 2002 Women’s Health Initiative (WHI) study misled an entire generation of doctors—and women—about the safety of hormone therapy.
The Big Mistake: A Study Designed to Fail the Question
The WHI was launched to test whether hormone therapy could prevent chronic diseases like heart disease, fractures, and colon cancer. But instead of enrolling women near menopause—where the benefits are strongest—they stacked the trial with older participants. The average age was 63, and many were more than 12 years past menopause.
Translation: they asked the right question (does HT prevent disease?), but tested it in the wrong group. And yet, the results were generalized to all women, even those for whom the therapy would have been appropriate.
Headlines Over Health
The trial was stopped early, not because of statistically significant findings, but because of fear—and a press release. The study’s leadership bypassed its own protocol, sidelined expert investigators, and sent out a panic-inducing message: Hormone therapy causes breast cancer.
The actual data? Didn’t show a statistically significant increase in breast cancer. And the increase in heart disease? Mostly in the first year, and mostly in older women. Meanwhile, benefits like fracture prevention and possible colorectal cancer reduction were buried.
What the WHI Ignored
- Estrogen alone (CEE) showed a trend toward lower breast cancer and heart disease risk.
- The rise in breast cancer cases in the combination group (CEE + MPA) was likely due to stimulating growth of existing tumors—not causing new ones.
- The women with no prior hormone therapy (HRT-naïve) didn’t show the same breast cancer increase.
- Early hormone therapy may reduce risk of coronary disease and dementia—but the study wasn’t powered to detect that.
The Real-World Fallout
After the WHI, HT prescriptions plummeted worldwide. Women suffered from untreated symptoms, quality of life deteriorated, and bone fractures and cardiovascular events increased. A Finnish registry showed a twofold increase in cardiovascular deaths in women who stopped HT.
All because of bad headlines based on misinterpreted science.
The Bottom Line
Hormone therapy isn’t one-size-fits-all. It isn’t magic. But for the right woman, at the right time, it can prevent disease, relieve symptoms, and even save lives.
We need to stop letting decades-old fear dictate modern care.
Let’s replace panic with precision—and finally give women access to the truth.
Dr. Aoife O’Sullivan is a family physician, board certified by the American Board of Family Physicians and a menopause specialist, certified by the North American Menopause Society, dedicated to empowering women through their midlife health journeys. She is the founder of Portland Menopause Doc, co-founder of the Portland Menopause Collective, podcaster on The Dusty Muffins, and an expert speaker, frequent podcast guest and active contributor to midlife women’s health research.
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