The WHI Earthquake: How One Trial Reversed 30 Years of Hormone Therapy Dogma
We told every menopausal woman to take hormones. For her heart. For her bones. For her brain. The WHI said we were wrong.
Post 1 of 8 in the From Routine to Regret: Gynecology Edition.
In 1966, Robert Wilson published “Feminine Forever.” The book argued that menopause was a hormone deficiency disease, curable and totally preventable. Just take estrogen. Stay young. Stay feminine. Stay relevant.
The book became a bestseller. The idea became dogma. By the 1990s, Premarin was the best-selling drug in America. One-third of prescriptions were written for women well past menopause. The American Heart Association, the American College of Physicians, and ACOG all agreed: estrogen protected against heart disease and osteoporosis. Every menopausal woman should be on hormone replacement therapy. The question was not whether to prescribe. The question was why any woman would decline.
Then on July 9, 2002, the Women’s Health Initiative announced that the combined estrogen-progestin arm of its randomized trial had been stopped early. The data monitoring committee concluded that the risks exceeded the benefits. HRT increased breast cancer, stroke, pulmonary embolism, and coronary heart disease.
Within months, 80% of American women on HRT stopped. Premarin sales collapsed. The “Feminine Forever” era was over.
The WHI was not just a trial result. It was a professional earthquake. It exposed how an entire specialty had built decades of clinical practice on observational data, biological plausibility, and pharmaceutical marketing rather than randomized evidence.
This post covers the first five abandoned menopause practices. Each was routine. Each was confident. Each was wrong.
🎯 Free Subscriber Bottom Line: For 30+ years, hormone replacement therapy was prescribed to virtually all menopausal women for disease prevention. The WHI (2002) showed that combined HRT increased breast cancer, stroke, PE, and heart disease. The HERS trial (1998) had already shown no cardiovascular benefit. The WHIMS trial (2003) showed doubled dementia risk. An entire generation of women received a treatment that caused the diseases it was supposed to prevent.
Below, paid subscribers get: - The complete timeline from “Feminine Forever” to the WHI - Unopposed estrogen and the endometrial cancer disaster of the 1970s - HERS vs WHI: how two trials dismantled cardiovascular protection claims - WHIMS and the dementia reversal - Why long-term HRT persisted despite evidence - The Wyeth ghostwriting scandal and its role in sustaining the dogma - What the “timing hypothesis” actually shows and what it doesn’t.
