Dr. Tabatha Barber breaks down the 2002 Women's Health Initiative study that scared millions away from HRT. The trial used synthetic hormones, not bioidentical ones, and found increased blood clots, stroke, and breast cancer. The distinction between what was tested and what women take now matters.
I really want to talk about bioidentical hormone replacement therapy, because. Hormone replacement gets a bad rap. And I constantly have women tell me they're scared of hormones. And it all stems from the Women's Health Initiative study that came out in 2002. So it was right when I was in medical school and beginning my residency training. All of the pieces of this study started to come out, and the media jumped on it and skewed the results and caused a lot of fear and panic. Essentially, what I saw was doctors just flat out taking everybody off of their hormone replacement therapy overnight. No weaning, no regard for how women felt. And it was a really sad time for women in our health history. And I just. I have so many stories in my mind of women suffering and all of the devastation that they went through, being taken off of their hormones abruptly or going through menopause and being very scared of their hormones and assuming they were going to get breast cancer and die, and all of these terrible things because of what was being portrayed in the media from this study. So I really want you to understand that this study is about synthetic hormones, and it very much matters what type of hormones you're studying when you go and tell the results and the outcomes and the risks involved. So the study had two arms to it. It was one where women were just given estrogen if they didn't have uterus, because the conventional thought is that progesterone is only needed to protect the uterus from unopposed estrogen. We now know that your whole body needs progesterone to be protected from unopposed estrogen. So it is still standard of care, unfortunately for many gynecologists, to give you only estrogen if you no longer have a uterus. And you can probably attest to the fact that it doesn't feel very good or balanced if that's you. Some women will finally feel relief from hot flashes, night sweats, things like that. But when you have unbalanced estrogen and no progesterone, it usually feels like weight gain or constant bloating, swelling, brain fog, anxiety, insomnia. Those are all symptoms of low progesterone and imbalanced estrogen. It turns out we need progesterone for more than just our uterus. Anyway, back to the study. The study had women with no uterus taking estrogen, and that was conjugated equine estrogen made from horse urine. It's a synthetic hormone. Then the other portion of the women who had uteruses were taking conjugated equine estrogen and a synthetic progestin. At the time, it was thought that synthetic progestins work just as the same as our body's natural progesterone. It turns out that it actually works the opposite in most systems. The only place that it really has the same benefit or effect is in the uterus. Synthetic progestins do seem to protect the uterus from any kind of estrogen. But synthetic progestins cause weight gain, mood swings like anxiety, depression, fatigue, all of these side effects that none of us want. Right. And so synthetic progestins are what's in birth control pills. Nuvaring's Nexplanon rod that goes in your arm, the depo shot, the IUDs, like Mirena, Kyleena, Skyla. They're all at varying doses and different forms of synthetic progestins, but nonetheless, they're not progesterone. You can potentially have all of these side effects. The study had these two arms of women, that's what they call them in a study is an arm. What they found was the women on estrogen alone had increased risk of blood clot and stroke, and the women with the estrogen plus progestin had an increased risk of breast cancer. And that is why the study was stopped.
