Is Fear Driving Your Decision About Menopausal Hormone Therapy?

Back in 2002, the Women’s Health Initiative (WHI) released results from a large hormone therapy study, and everything changed.

Headlines exploded. Fear spread like wildfire. And seemingly overnight, thousands of women were taken off their hormones.

Here’s the truth:

The WHI findings were misconstrued, poorly contextualized, and never meant to address menopause symptoms. And yet, for two decades, both women and their healthcare providers have made decisions based on fear, not fact.

If you are familiar with the history of women in medicine, you know this isn’t the first time we’ve been misled. But we’re working on it.

And I’m starting by educating you.

What Was the WHI Study Actually About?

Let’s start with the facts:

• The WHI was designed to evaluate the effects of hormone therapy on coronary heart disease, non-fatal heart attacks, and coronary heart disease–related deaths, not menopause symptoms.
• There were two groups: women with a uterus and women without.
• The hormones studied were conjugated equine estrogen (CEE) — a synthetic oral estrogen — and medroxyprogesterone acetate (MPA).
• The average age of participants was 63.2 years, with over 21% of participants over the age of 70.
• The study was stopped early: 5.3 years into a planned 8.5-year duration.

What Women Heard

The media takeaway was: Hormone therapy increases your risk of breast cancer.

So women stopped their hormones. Doctors stopped prescribing them. And fear shaped care for the next two decades.

But What Did the WHI Study Actually Show?

In women with a uterus who took CEE + MPA at an average age of 63.2:

• The risk of breast cancer was 5 in 1,000 women per year
• In the placebo group, it was 4 in 1,000 women per year

That’s a change of 1 in 1,000, which was not statistically significant.

What else did they find?

• Decreased risk of colon cancer
• Decreased risk of osteoporosis-related fractures

Important Context You Deserve to Know

• The women in the WHI were older than the average woman starting hormone therapy in perimenopause or early menopause.
• The formulations used — CEE and MPA — are not the same as those most commonly prescribed today.
• Women in the estrogen-only group had a lower incidence of breast cancer.

The risk of breast cancer associated with hormone therapy is comparable to or lower than the risk associated with alcohol use or obesity. Yet, we don’t see fear-based messaging around those.

So What Should You Take Away?

Hormone therapy may not be the right choice for every woman. But every woman deserves access to accurate information, modern research, and the right to choose based on facts, not fear.

If you’ve been hesitant about hormone therapy because of what you heard 20 years ago, it’s time to revisit the data.

You deserve care that’s current, compassionate, and woman-centered.

References:

Haver, M.C. The New Menopause.

North American Menopause Society (NAMS). “The 2022 Hormone Therapy Position Statement of The North American Menopause Society.”

Menopause: The Journal of The North American Menopause Society, Vol. 29, No. 7, pp. 767–794.

DOI: 10.1097/GME.0000000000002028